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Donaghue KC, Liew G. Measuring Outcomes of Diabetic Retinopathy Screening: What Is Important? Diabetes Care 2024; 47:930-932. [PMID: 38768335 DOI: 10.2337/dci24-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Child and Adolescent Health, The University of Sydney School of Medicine, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Gerald Liew
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Clinical Ophthalmology and Eye Health, The University of Sydney School of Medicine, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
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Van Vu K, Mitchell P, Detaram HD, Burlutsky G, Liew G, Gopinath B. Prevalence and risk factors for impaired activities of daily living in patients with neo-vascular age-related macular degeneration who present for anti-VEGF treatment. Eye (Lond) 2024:10.1038/s41433-024-02983-9. [PMID: 38374365 DOI: 10.1038/s41433-024-02983-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 01/15/2024] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND/OBJECTIVES To assess the prevalence and correlates of impaired activities of daily living (ADLs) in patients with neovascular age-related macular degeneration (nAMD) who present for anti-vascular endothelial growth factor (VEGF) therapy. METHODS In a clinic-based cohort of 437 patients with nAMD who presented for anti-VEGF therapy, the Older American Resources and Services Scale (OARS) was administered to assess for impairments in basic, instrumental and total ADL. Logistic regression analyses were conducted to determine odds ratios (OR) and 95% confidence intervals (CI) for factors associated with ADL impairment. RESULTS The prevalence of impaired basic, instrumental and total ADL was 37.76%, 67.82% and 39.59%, respectively. In multivariate-adjusted models, moderate visual impairment [OR 5.65, 95% CI (2.31-13.83) and blindness [OR 5.43, 95% CI (2.09-14.12)] were associated with greater odds of impaired total ADL. Depressive symptoms [OR 2.08, 95% CI (1.08-4.00)], the presence of any disability [OR 3.16, 95% CI (1.64-0.07)] and never driving [OR 4.00, 95% CI (1.60-10.00)] were also positively associated with total ADL impairment. Better vision-related quality of life (QoL) was inversely associated with impaired instrumental ADL whilst higher health-related QoL scores were associated with decreased odds of total ADL impairment. CONCLUSIONS There is a high prevalence rate of ADL impairment among nAMD patients presenting for therapy. Visual impairment, never driving, poor physical and mental health increased the odds of experiencing ADL impairment whilst better VRQoL and HRQoL reduced the odds of impairment.
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Affiliation(s)
- Kim Van Vu
- Centre for Vision Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Paul Mitchell
- Centre for Vision Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Harshil Dharamdasani Detaram
- Centre for Vision Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - George Burlutsky
- Macquarie University Hearing, Department of Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Gerald Liew
- Centre for Vision Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Bamini Gopinath
- Macquarie University Hearing, Department of Health Sciences, Macquarie University, Sydney, NSW, Australia.
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Girgis S, Do HHJ, Leong B, Liew G. Incidence and associations of vitreous haemorrhage in proliferative diabetic retinopathy. Clin Exp Ophthalmol 2024; 52:108-110. [PMID: 37963814 DOI: 10.1111/ceo.14319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023]
Affiliation(s)
- Shenouda Girgis
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Helen Hyun-Jin Do
- Department of Ophthalmology, South West Retina, Retina Associates, Liverpool, New South Wales, Australia
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Belinda Leong
- Department of Ophthalmology, South West Retina, Retina Associates, Liverpool, New South Wales, Australia
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Gerald Liew
- Department of Ophthalmology, South West Retina, Retina Associates, Liverpool, New South Wales, Australia
- Centre for Vision Research, Westmead Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
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Betzler BK, Chee EYL, He F, Lim CC, Ho J, Hamzah H, Tan NC, Liew G, McKay GJ, Hogg RE, Young IS, Cheng CY, Lim SC, Lee AY, Wong TY, Lee ML, Hsu W, Tan GSW, Sabanayagam C. Deep learning algorithms to detect diabetic kidney disease from retinal photographs in multiethnic populations with diabetes. J Am Med Inform Assoc 2023; 30:1904-1914. [PMID: 37659103 PMCID: PMC10654858 DOI: 10.1093/jamia/ocad179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/04/2023] Open
Abstract
OBJECTIVE To develop a deep learning algorithm (DLA) to detect diabetic kideny disease (DKD) from retinal photographs of patients with diabetes, and evaluate performance in multiethnic populations. MATERIALS AND METHODS We trained 3 models: (1) image-only; (2) risk factor (RF)-only multivariable logistic regression (LR) model adjusted for age, sex, ethnicity, diabetes duration, HbA1c, systolic blood pressure; (3) hybrid multivariable LR model combining RF data and standardized z-scores from image-only model. Data from Singapore Integrated Diabetic Retinopathy Program (SiDRP) were used to develop (6066 participants with diabetes, primary-care-based) and internally validate (5-fold cross-validation) the models. External testing on 2 independent datasets: (1) Singapore Epidemiology of Eye Diseases (SEED) study (1885 participants with diabetes, population-based); (2) Singapore Macroangiopathy and Microvascular Reactivity in Type 2 Diabetes (SMART2D) (439 participants with diabetes, cross-sectional) in Singapore. Supplementary external testing on 2 Caucasian cohorts: (3) Australian Eye and Heart Study (AHES) (460 participants with diabetes, cross-sectional) and (4) Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) (265 participants with diabetes, cross-sectional). RESULTS In SiDRP validation, area under the curve (AUC) was 0.826(95% CI 0.818-0.833) for image-only, 0.847(0.840-0.854) for RF-only, and 0.866(0.859-0.872) for hybrid. Estimates with SEED were 0.764(0.743-0.785) for image-only, 0.802(0.783-0.822) for RF-only, and 0.828(0.810-0.846) for hybrid. In SMART2D, AUC was 0.726(0.686-0.765) for image-only, 0.701(0.660-0.741) in RF-only, 0.761(0.724-0.797) for hybrid. DISCUSSION AND CONCLUSION There is potential for DLA using retinal images as a screening adjunct for DKD among individuals with diabetes. This can value-add to existing DLA systems which diagnose diabetic retinopathy from retinal images, facilitating primary screening for DKD.
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Affiliation(s)
- Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore
| | - Evelyn Yi Lyn Chee
- School of Computing, National University of Singapore, 117417, Singapore
| | - Feng He
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
| | - Cynthia Ciwei Lim
- Department of Renal Medicine, Singapore General Hospital, 168753, Singapore
| | - Jinyi Ho
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
| | - Haslina Hamzah
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore Health Services, 168582, Singapore
| | - Gerald Liew
- Westmead Institute for Medical Research, University of Sydney, NSW 2145, Australia
| | - Gareth J McKay
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, United Kingdom
| | - Ruth E Hogg
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, United Kingdom
| | - Ian S Young
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, United Kingdom
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, 169857, Singapore
| | - Su Chi Lim
- Khoo Teck Puat Hospital, 768828, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, 117549, Singapore
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, WA 98104, United States
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, 169857, Singapore
| | - Mong Li Lee
- School of Computing, National University of Singapore, 117417, Singapore
| | - Wynne Hsu
- School of Computing, National University of Singapore, 117417, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, 169857, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751, Singapore
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, 169857, Singapore
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Nguyen H, Di Tanna GL, Do V, Mitchell P, Liew G, Keay L. 15-year incidence of driving cessation and associated risk factors: The Blue Mountains Eye Study. Maturitas 2023; 177:107796. [PMID: 37454471 DOI: 10.1016/j.maturitas.2023.107796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To report the 15-year incidence of driving cessation and its associated vision-related risk factors in an older Australian population-based cohort. STUDY DESIGN 15-year data from a sample of 2379 participants who indicated that they were driving at baseline from The Blue Mountains Eye Study was analysed. Questions about driving cessation was asked at all four visits and was recorded as a binary response (Yes/No). Clinical vision examinations were performed at each visit to determine presenting and best-corrected visual acuity and any incident eye diseases (Yes/No). MAIN OUTCOME MEASURES The cumulative 15-year incidence of driving cessation was calculated using interval-censored data progression-free survival analyses. Age- and sex-adjusted and multivariable-adjusted interval-censored Cox proportional hazard models were used to report the hazard ratios (HRs) for associations of baseline and incident vision status with driving cessation. RESULTS The 15-year cumulative incidence of driving cessation amongst the 2379 participants was 20.7 %, with women more likely to cease driving than men (p = 0.0005). Cataract (HR 1.98 (95 % confidence interval(Cl) 1.45-2.71)) and age-related macular degeneration (HR 1.85 (95%Cl 1.37-2.50)) were associated with increased risk of driving cessation whilst presenting and best-corrected visual acuity in the better eye were protective against cessation (presenting: HR 0.96 (95%Cl 0.95-0.98); best-corrected: HR 0.93 (95%Cl 0.91-0.95)) in age- and sex-adjusted models, with these factors remaining independently associated in the multivariable-adjusted models. CONCLUSION Cumulative incidence of driving cessation increased with older age and was higher in females. Cataract and age-related macular degeneration were independently associated with cessation, whilst better visual acuity at baseline helped prolong driving.
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Affiliation(s)
- Helen Nguyen
- School of Optometry and Vision Science, Faculty of Science, The University of New South Wales, NSW, Australia; Centre for Vision Research, Department of Ophthalmology, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia.
| | - Gian Luca Di Tanna
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia; The University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Vu Do
- Centre for Vision Research, Department of Ophthalmology, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, Faculty of Science, The University of New South Wales, NSW, Australia; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
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Gyawali R, Toomey M, Stapleton F, Ho KC, Keay L, Pye DC, Katalinic P, Liew G, Hsing YI, Ramke J, Gentle A, Webber AL, Schmid KL, Bentley S, Hibbert P, Wiles L, Jalbert I. Clinical indicators for diabetic eyecare delivered by optometrists in Australia: a Delphi study. Clin Exp Optom 2023:1-10. [PMID: 37848180 DOI: 10.1080/08164622.2023.2253792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/28/2023] [Indexed: 10/19/2023] Open
Abstract
CLINICAL RELEVANCE Valid and updated clinical indicators can serve as important tools in assessing and improving eyecare delivery. BACKGROUND Indicators for diabetic eyecare in Australia were previously developed from guidelines published before 2013 and then used to assess the appropriateness of care delivery through a nationwide patient record card audit (the iCareTrack study). To reflect emerging evidence and contemporary practice, this study aimed to update clinical indicators for optometric care for people with type 2 diabetes in Australia. METHODS Forty-five candidate indicators, including existing iCareTrack and new indicators derived from nine high-quality evidence-based guidelines, were generated. A two-round modified Delphi process where expert panel members rated the impact, acceptability, and feasibility of the indicators on a 9-point scale and voted for inclusion or exclusion of the candidate indicators was used. Consensus on inclusion was reached when the median scores for impact, acceptability, and feasibility were ≥7 and >75% of experts voted for inclusion. RESULTS Thirty-two clinical indicators with high acceptability, impact and feasibility ratings (all median scores: 9) were developed. The final indicators were related to history taking (n = 12), physical examination (n = 8), recall period (n = 5), referral (n = 5), and patient education/communication (n = 2). Most (14 of 15) iCareTrack indicators were retained either in the original format or with modifications. New indicators included documenting the type of diabetes, serum lipid level, pregnancy, systemic medications, nephropathy, Indigenous status, general practitioner details, pupil examination, intraocular pressure, optical coherence tomography, diabetic retinopathy grading, recall period for high-risk diabetic patients without retinopathy, referral of high-risk proliferative retinopathy, communication with the general practitioner, and patient education. CONCLUSION A set of 32 updated diabetic eyecare clinical indicators was developed based on contemporary evidence and expert consensus. These updated indicators inform the development of programs to assess and enhance the eyecare delivery for people with diabetes in Australia.
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Affiliation(s)
- Rajendra Gyawali
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Melinda Toomey
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kam Chun Ho
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - David C Pye
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Paula Katalinic
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Gerald Liew
- Centre for Vision Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Yan Inez Hsing
- Department of Optometry, Okko Eye Specialist Centre, Upper Mount Gravatt, Queensland, Australia
| | - Jacqueline Ramke
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Alex Gentle
- School of Medicine, Deakin University, Geelong, Victoria Australia
| | - Ann L Webber
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Katrina L Schmid
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sharon Bentley
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Louise Wiles
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
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Vu KV, Mitchell P, Detaram HD, Burlutsky G, Liew G, Gopinath B. Risk factors for poorer quality of life in patients with neovascular age-related macular degeneration: a longitudinal clinic-based study. Eye (Lond) 2023; 37:2736-2743. [PMID: 36697902 PMCID: PMC10482823 DOI: 10.1038/s41433-023-02407-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 11/29/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND/OBJECTIVES To examine the risk factors for poor vision-related and health-related quality of life (QoL) in patients with neovascular age-related macular degeneration (nAMD) who present for anti-vascular endothelial growth factor (anti-VEGF) therapy. METHODS In a clinic-based cohort of 547 nAMD patients who presented for treatment, the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ25), Short-Form 36 (SF-36) and EuroQoL EQ-5D-5L questionnaires were administered to assess vision-related and health-related QoL. Of these, 83 participants were followed up one-year later to provide longitudinal data. RESULTS Individuals with mild or moderate visual impairment or blindness at baseline had significantly lower NEI-VFQ-25 scores at follow-up. The presence of ≥3 chronic diseases was associated with lower SF-36 mental component scores (MCS) (p = 0.04) and EQ-VAS scores (p = 0.05). Depressive symptoms were associated with significantly lower MCS (p < 0.0001) and EQ-VAS scores (p = 0.02). Individuals with versus without impaired basic activities of daily living (ADLs) exhibited NEI-VFQ-25 and EQ-VAS scores that were 10.96 (p = 0.03) and 0.13 (p = 0.02) points lower. Those with impaired instrumental ADLs scored 11.62 (p = 0.02), 13.13 (p < 0.0001) and 15.8 (p = 0.0012) points lower in the NEI-VFQ-25, SF-36 physical component score and EQ-5D-5L summary score, respectively. CONCLUSIONS The QoL of nAMD patients is affected by visual acuity as well as patients' medical history, mental health and functional status.
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Affiliation(s)
- Kim Van Vu
- Centre for Vision Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Paul Mitchell
- Centre for Vision Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Harshil Dharamdasani Detaram
- Centre for Vision Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - George Burlutsky
- Macquarie University Hearing, Department of Linguistics, Macquarie University, Sydney, NSW, Australia
| | - Gerald Liew
- Centre for Vision Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Bamini Gopinath
- Macquarie University Hearing, Department of Linguistics, Macquarie University, Sydney, NSW, Australia.
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Weerasinghe LS, Dunn HP, Fung AT, Maberly G, Cheung NW, Weerasinghe DP, Liew G, Do H, Hng TM, Pryke A, Marks SI, Nguyen H, Jayaballa R, Gurung S, Ford B, Bishay RH, Girgis CM, Meyerowitz-Katz G, Keay L, White AJ. Diabetic Retinopathy Screening at the Point of Care (DR SPOC): detecting undiagnosed and vision-threatening retinopathy by integrating portable technologies within existing services. BMJ Open Diabetes Res Care 2023; 11:e003376. [PMID: 37532459 PMCID: PMC10401227 DOI: 10.1136/bmjdrc-2023-003376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION The aim of this study was to determine the prevalence of diabetic retinopathy (DR) in a low socioeconomic region of a high-income country, as well as determine the diagnostic utility of point-of-care screening for high-risk populations in tertiary care settings. RESEARCH DESIGN AND METHODS This was a cross-sectional study of patients with diabetes attending foot ulcer or integrated care diabetes clinics at two Western Sydney hospitals (n=273). DR was assessed using portable, two-field, non-mydriatic fundus photography and combined electroretinogram/ pupillometry (ERG). With mydriatic photographs used as the reference standard, sensitivity and specificity of the devices were determined. Prevalence of DR and vision-threatening diabetic retinopathy (VTDR) were reported, with multivariate logistic regression used to identify predictors of DR. RESULTS Among 273 patients, 39.6% had any DR, while 15.8% had VTDR, of whom 59.3% and 62.8% were previously undiagnosed, respectively. Non-mydriatic photography demonstrated 20.2% sensitivity and 99.5% specificity for any DR, with a 56.7% screening failure rate. Meanwhile, mydriatic photography produced high-quality images with a 7.6% failure rate. ERG demonstrated 72.5% sensitivity and 70.1% specificity, with a 15.0% failure rate. The RETeval ERG was noted to have an optimal DR cut-off score at 22. Multivariate logistic regression identified an eGFR of ≤29 mL/min/1.73 m2, HbA1c of ≥7.0%, pupil size of <4 mm diameter, diabetes duration of 5-24 years and RETeval score of ≥22 as strong predictors of DR. CONCLUSION There is a high prevalence of vision-threatening and undiagnosed DR among patients attending high-risk tertiary clinics in Western Sydney. Point-of-care DR screening using portable, mydriatic photography demonstrates potential as a model of care which is easily accessible, targeted for high-risk populations and substantially enhances DR detection.
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Affiliation(s)
- Lakni Shahanika Weerasinghe
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Hamish Paul Dunn
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Adrian T Fung
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Glen Maberly
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Ngai Wah Cheung
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Daminda P Weerasinghe
- Department of Mathematics and Statistics, Macquarie University, Sydney, New South Wales, Australia
| | - Gerald Liew
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Helen Do
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Tien-Ming Hng
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbeltown, New South Wales, Australia
| | - Alison Pryke
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Samuel I Marks
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Helen Nguyen
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Rajini Jayaballa
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbeltown, New South Wales, Australia
| | - Seema Gurung
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Belinda Ford
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia
| | - Ramy H Bishay
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbeltown, New South Wales, Australia
| | - Christian M Girgis
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | | | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia
| | - Andrew J White
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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Liew G, Xie J, Nguyen H, Keay L, Kamran Ikram M, McGeechan K, Klein BEK, Jin Wang J, Mitchell P, Klaver CCW, Lamoureux EL, Wong TY. Hypertensive retinopathy and cardiovascular disease risk: 6 population-based cohorts meta-analysis. Int J Cardiol Cardiovasc Risk Prev 2023; 17:200180. [PMID: 36936860 PMCID: PMC10020621 DOI: 10.1016/j.ijcrp.2023.200180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/13/2023] [Accepted: 02/22/2023] [Indexed: 03/07/2023]
Abstract
Background The cardiovascular risk associated with different levels of hypertensive retinopathy, including mild, remains unclear. We performed an individual participant meta-analysis from 6 population-based cohort studies to determine the relationship of hypertensive retinopathy with incident cardiovascular outcomes. Methods We identified cohort studies that objectively assessed hypertensive retinopathy from photographs, documented incident cardiovascular outcomes, and were population-based. Six studies contributed data from 11,013 individuals at baseline with 5-13 years follow-up. Participants were recruited if they had hypertension and did not have confounding conditions such as diabetic retinopathy. Main outcome measures were incident coronary heart disease (CHD), stroke and a composite endpoint of cardiovascular disease (CHD or stroke). Pooled estimates of incident risk ratios (IRR) were obtained after adjusting for age, gender, systolic blood pressure, serum total cholesterol, high density lipoprotein and smoking. Results Among eligible participants with hypertension and without diabetes, there were 1018/9662 (10.5%) incident CHD events, 708/11,013 (6.4%) incident stroke events and 1317/9378 (14.0%) incident CVD events. Mild hypertensive retinopathy was associated with increased risk of CVD (IRR 1.13, 95% CI 1.00 to 1.27) and CHD (IRR 1.17, 95% CI 1.02 to 1.34) but not stroke; moderate hypertensive retinopathy was associated with increased risk of CVD (IRR 1.25 95% CI 1.02 to 1.53) but not stroke or CHD individually. Conclusions In persons with hypertension, both mild and moderate hypertensive retinopathy were associated with higher CVD risk.
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Affiliation(s)
- Gerald Liew
- Centre for Vision Research, Department of Ophthalmology, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Corresponding author. Centre for Vision Research, The Westmead Institute for Medical Research, The University of Sydney, 176 Hawkesbury Road, Westmead, NSW, 2145, Australia.
| | - Jing Xie
- Centre for Vision Research, Department of Ophthalmology, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Helen Nguyen
- Centre for Vision Research, Department of Ophthalmology, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - M. Kamran Ikram
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore
| | - Kevin McGeechan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Screening and Test Evaluation Program, School of Public Health, University of Sydney, Sydney, Australia
| | - Barbara EK. Klein
- Department of Ophthalmology & Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jie Jin Wang
- Centre for Vision Research, Department of Ophthalmology, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Screening and Test Evaluation Program, School of Public Health, University of Sydney, Sydney, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
| | - Caroline CW. Klaver
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ecosse L. Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Screening and Test Evaluation Program, School of Public Health, University of Sydney, Sydney, Australia
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Tien Y. Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Screening and Test Evaluation Program, School of Public Health, University of Sydney, Sydney, Australia
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
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10
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Mathieson I, Day FR, Barban N, Tropf FC, Brazel DM, Vaez A, van Zuydam N, Bitarello BD, Gardner EJ, Akimova ET, Azad A, Bergmann S, Bielak LF, Boomsma DI, Bosak K, Brumat M, Buring JE, Cesarini D, Chasman DI, Chavarro JE, Cocca M, Concas MP, Davey Smith G, Davies G, Deary IJ, Esko T, Faul JD, Franco O, Ganna A, Gaskins AJ, Gelemanovic A, de Geus EJC, Gieger C, Girotto G, Gopinath B, Grabe HJ, Gunderson EP, Hayward C, He C, van Heemst D, Hill WD, Hoffmann ER, Homuth G, Hottenga JJ, Huang H, Hyppӧnen E, Ikram MA, Jansen R, Johannesson M, Kamali Z, Kardia SLR, Kavousi M, Kifley A, Kiiskinen T, Kraft P, Kühnel B, Langenberg C, Liew G, Lind PA, Luan J, Mägi R, Magnusson PKE, Mahajan A, Martin NG, Mbarek H, McCarthy MI, McMahon G, Medland SE, Meitinger T, Metspalu A, Mihailov E, Milani L, Missmer SA, Mitchell P, Møllegaard S, Mook-Kanamori DO, Morgan A, van der Most PJ, de Mutsert R, Nauck M, Nolte IM, Noordam R, Penninx BWJH, Peters A, Peyser PA, Polašek O, Power C, Pribisalic A, Redmond P, Rich-Edwards JW, Ridker PM, Rietveld CA, Ring SM, Rose LM, Rueedi R, Shukla V, Smith JA, Stankovic S, Stefánsson K, Stöckl D, Strauch K, Swertz MA, Teumer A, Thorleifsson G, Thorsteinsdottir U, Thurik AR, Timpson NJ, Turman C, Uitterlinden AG, Waldenberger M, Wareham NJ, Weir DR, Willemsen G, Zhao JH, Zhao W, Zhao Y, Snieder H, den Hoed M, Ong KK, Mills MC, Perry JRB. Genome-wide analysis identifies genetic effects on reproductive success and ongoing natural selection at the FADS locus. Nat Hum Behav 2023; 7:790-801. [PMID: 36864135 DOI: 10.1038/s41562-023-01528-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/12/2023] [Indexed: 03/04/2023]
Abstract
Identifying genetic determinants of reproductive success may highlight mechanisms underlying fertility and identify alleles under present-day selection. Using data in 785,604 individuals of European ancestry, we identified 43 genomic loci associated with either number of children ever born (NEB) or childlessness. These loci span diverse aspects of reproductive biology, including puberty timing, age at first birth, sex hormone regulation, endometriosis and age at menopause. Missense variants in ARHGAP27 were associated with higher NEB but shorter reproductive lifespan, suggesting a trade-off at this locus between reproductive ageing and intensity. Other genes implicated by coding variants include PIK3IP1, ZFP82 and LRP4, and our results suggest a new role for the melanocortin 1 receptor (MC1R) in reproductive biology. As NEB is one component of evolutionary fitness, our identified associations indicate loci under present-day natural selection. Integration with data from historical selection scans highlighted an allele in the FADS1/2 gene locus that has been under selection for thousands of years and remains so today. Collectively, our findings demonstrate that a broad range of biological mechanisms contribute to reproductive success.
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Affiliation(s)
- Iain Mathieson
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Felix R Day
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Nicola Barban
- Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Felix C Tropf
- Nuffield College, University of Oxford, Oxford, UK
- École Nationale de la Statistique et de L'administration Économique (ENSAE), Paris, France
- Center for Research in Economics and Statistics (CREST), Paris, France
| | - David M Brazel
- Nuffield College, University of Oxford, Oxford, UK
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford, UK
| | - Ahmad Vaez
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Bioinformatics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Natalie van Zuydam
- Beijer Laboratory and Department of Immunology, Genetics and Pathology, Uppsala University and SciLifeLab, Uppsala, Sweden
| | - Bárbara D Bitarello
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eugene J Gardner
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Evelina T Akimova
- Nuffield College, University of Oxford, Oxford, UK
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford, UK
| | - Ajuna Azad
- DNRF Center for Chromosome Stability, Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sven Bergmann
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
| | - Lawrence F Bielak
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Dorret I Boomsma
- Department of Biological Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development (AR&D) Research Institute, Amsterdam, the Netherlands
| | | | - Marco Brumat
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Julie E Buring
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - David Cesarini
- Department of Economics, New York University, New York, NY, USA
- Research Institute for Industrial Economics, Stockholm, Sweden
- National Bureau of Economic Research, Cambridge, MA, USA
| | - Daniel I Chasman
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jorge E Chavarro
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Massimiliano Cocca
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Maria Pina Concas
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | | | - Gail Davies
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Tõnu Esko
- Estonian Genome Center, University of Tartu, Tartu, Estonia
- Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
| | - Jessica D Faul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Oscar Franco
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Andrea Ganna
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- Analytic and Translational Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Audrey J Gaskins
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Eco J C de Geus
- Department of Biological Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Christian Gieger
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Giorgia Girotto
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Bamini Gopinath
- Centre for Vision Research, Westmead Institute for Medical Research and Department of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
| | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Erica P Gunderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Caroline Hayward
- Medical Research Council Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Chunyan He
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Internal Medicine, Division of Medical Oncology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Diana van Heemst
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - W David Hill
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Eva R Hoffmann
- DNRF Center for Chromosome Stability, Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, University of Greifswald, Greifswald, Germany
| | - Jouke Jan Hottenga
- Department of Biological Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hongyang Huang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elina Hyppӧnen
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rick Jansen
- Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Magnus Johannesson
- Department of Economics, Stockholm School of Economics, Stockholm, Sweden
| | - Zoha Kamali
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Bioinformatics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sharon L R Kardia
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Annette Kifley
- Centre for Vision Research, Westmead Institute for Medical Research and Department of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
| | - Tuomo Kiiskinen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- National Institute for Health and Welfare, Helsinki, Finland
| | - Peter Kraft
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Brigitte Kühnel
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Gerald Liew
- Centre for Vision Research, Westmead Institute for Medical Research and Department of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
| | - Penelope A Lind
- Psychiatric Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Jian'an Luan
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Reedik Mägi
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anubha Mahajan
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas G Martin
- Genetic Epidemiology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Hamdi Mbarek
- Department of Biological Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Qatar Genome Programme, Qatar Foundation Research, Development and Innovation, Qatar Foundation, Doha, Qatar
| | - Mark I McCarthy
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - George McMahon
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sarah E Medland
- Psychiatric Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Thomas Meitinger
- Institute of Human Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Andres Metspalu
- Estonian Genome Center, University of Tartu, Tartu, Estonia
- Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | | | - Lili Milani
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Stacey A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Paul Mitchell
- Centre for Vision Research, Westmead Institute for Medical Research and Department of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
| | - Stine Møllegaard
- Department of Sociology, University of Copenhagen, Copenhagen, Denmark
| | - Dennis O Mook-Kanamori
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Anna Morgan
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Peter J van der Most
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ilja M Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Raymond Noordam
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center/GGZ inGeest, Amsterdam, the Netherlands
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Patricia A Peyser
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Ozren Polašek
- University of Split School of Medicine, Split, Croatia
- Algebra University College, Zagreb, Croatia
| | - Chris Power
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Paul Redmond
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Janet W Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Paul M Ridker
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Cornelius A Rietveld
- Erasmus University Rotterdam Institute for Behavior and Biology, Rotterdam, the Netherlands
- Department of Applied Economics, Erasmus School of Economics, Rotterdam, the Netherlands
| | - Susan M Ring
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | | | - Rico Rueedi
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Vallari Shukla
- DNRF Center for Chromosome Stability, Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jennifer A Smith
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Stasa Stankovic
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | | | - Doris Stöckl
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Konstantin Strauch
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University, Mainz, Germany
- Institute of Genetic Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Chair of Genetic Epidemiology, IBE, Faculty of Medicine, LMU, Munich, Germany
| | - Morris A Swertz
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | | | - A Roy Thurik
- Erasmus University Rotterdam Institute for Behavior and Biology, Rotterdam, the Netherlands
- Department of Applied Economics, Erasmus School of Economics, Rotterdam, the Netherlands
- Montpellier Business School, Montpellier, France
| | | | - Constance Turman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - André G Uitterlinden
- Erasmus University Rotterdam Institute for Behavior and Biology, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Melanie Waldenberger
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Nicholas J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - David R Weir
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Gonneke Willemsen
- Department of Biological Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jing Hau Zhao
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Wei Zhao
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Yajie Zhao
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marcel den Hoed
- Beijer Laboratory and Department of Immunology, Genetics and Pathology, Uppsala University and SciLifeLab, Uppsala, Sweden
| | - Ken K Ong
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Melinda C Mills
- Nuffield College, University of Oxford, Oxford, UK.
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford, UK.
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, the Netherlands.
| | - John R B Perry
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
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Jeyakumar S, Nguyen H, Robson D, Olsen N, Schnegg B, MacDonald P, Fraser C, Liew G, Hayward C, Muthiah K. Retinal Microvascular Remodelling Predicts Adverse Events in Continuous-Flow Left Ventricular Assist Device Supported Patients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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12
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Liew G, Tsang T, Marshall B, Saw M, Khachigian LM, Ong S, Ho IV, Wong V. Proportion of people with diabetic retinopathy and macular oedema varies by ethnicity in a tertiary retinal clinic in Australia: findings from the Liverpool Eye and Diabetes Study (LEADS). BMJ Open 2023; 13:e055404. [PMID: 36813495 PMCID: PMC9950882 DOI: 10.1136/bmjopen-2021-055404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE There are limited data on the influence of ethnicity on diabetic retinopathy (DR). We sought to determine the distribution of DR by ethnic group in Australia. DESIGN Clinic-based cross-sectional study. SETTING Participants with diabetes in a defined geographical region of Sydney, Australia, who attended a tertiary retina referral clinic. PARTICIPANTS The study recruited 968 participants. INTERVENTION Participants underwent a medical interview and retinal photography and scanning. PRIMARY OUTCOME MEASURES DR was defined from two-field retinal photographs. Diabetic macular oedema (DMO) was defined from spectral domain optical coherence tomography (OCT-DMO). The main outcomes were any DR, proliferative DR (PDR), clinically significant macular oedema (CSME), OCT-DMO and sight-threatening DR (STDR). RESULTS There was high proportion of any DR (52.3%), PDR (6.3%), CSME (19.7%), OCT-DMO (28.9%) and STDR (31.5%) in people attending a tertiary retinal clinic. Participants of Oceanian ethnicity had the highest proportion of any DR and STDR (70.4% and 48.1%, respectively), while the lowest proportion was in participants of East Asian ethnicity (38.3% and 15.8%, respectively). Proportion of any DR and STDR in Europeans was 54.5% and 30.3%, respectively. Independent predictive factors for diabetic eye disease were ethnicity, longer duration of diabetes, higher glycated haemoglobin and higher blood pressure. Even after adjusting for risk factors, Oceanian ethnicity remained associated with twofold higher odds of any DR (adjusted OR 2.10, 95% CI 1.10 to 4.00) and all other forms of DR including STDR (adjusted OR 2.22, 95% CI 1.19 to 4.15). CONCLUSION In people attending a tertiary retinal clinic, the proportion of people with DR varies among ethnic groups. The high proportion in persons of Oceanian ethnicity suggests a need for targeted screening of this at-risk group. In addition to traditional risks factors, ethnicity may be an additional independent predictor of DR.
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Affiliation(s)
- Gerald Liew
- Centre for Vision Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Tania Tsang
- South West Retina, Dept of Clinical Trials, Sydney, New South Wales, Australia
| | - Bridget Marshall
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mercy Saw
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Levon Michael Khachigian
- Vascular Biology and Translational Research, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Ong
- South West Retina, Dept of Clinical Trials, Sydney, New South Wales, Australia
| | - I-Van Ho
- South West Retina, Dept of Clinical Trials, Sydney, New South Wales, Australia
| | - Vincent Wong
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Khachigian LM, Liew G, Teo KYC, Wong TY, Mitchell P. Emerging therapeutic strategies for unmet need in neovascular age-related macular degeneration. J Transl Med 2023; 21:133. [PMID: 36810060 PMCID: PMC9942398 DOI: 10.1186/s12967-023-03937-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/27/2023] [Indexed: 02/23/2023] Open
Abstract
Neovascular age-related macular degeneration (nAMD) is a major cause of visual impairment and blindness. Anti-vascular endothelial growth factor (VEGF) agents, such as ranibizumab, bevacizumab, aflibercept, brolucizumab and faricimab have revolutionized the clinical management of nAMD. However, there remains an unmet clinical need for new and improved therapies for nAMD, since many patients do not respond optimally, may lose response over time or exhibit sub-optimal durability, impacting on real world effectiveness. Evidence is emerging that targeting VEGF-A alone, as most agents have done until recently, may be insufficient and agents that target multiple pathways (e.g., aflibercept, faricimab and others in development) may be more efficacious. This article reviews issues and limitations that have arisen from the use of existing anti-VEGF agents, and argues that the future may lie in multi-targeted therapies including alternative agents and modalities that target both the VEGF ligand/receptor system as well as other pathways.
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Affiliation(s)
- Levon M. Khachigian
- grid.1005.40000 0004 4902 0432Vascular Biology and Translational Research, Faculty of Medicine and Health, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052 Australia
| | - Gerald Liew
- grid.476921.fCentre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia
| | - Kelvin Y. C. Teo
- grid.419272.b0000 0000 9960 1711Singapore National Eye Centre and Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore
| | - Tien Y. Wong
- grid.419272.b0000 0000 9960 1711Singapore National Eye Centre and Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore ,grid.12527.330000 0001 0662 3178Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Paul Mitchell
- grid.476921.fCentre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia
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14
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Quek TC, Takahashi K, Kang HG, Thakur S, Deshmukh M, Tseng RMWW, Nguyen H, Tham YC, Rim TH, Kim SS, Yanagi Y, Liew G, Cheng CY. Predictive, preventive, and personalized management of retinal fluid via computer-aided detection app for optical coherence tomography scans. EPMA J 2022; 13:547-560. [PMID: 36505893 PMCID: PMC9727042 DOI: 10.1007/s13167-022-00301-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/25/2022] [Indexed: 11/21/2022]
Abstract
Aims Computer-aided detection systems for retinal fluid could be beneficial for disease monitoring and management by chronic age-related macular degeneration (AMD) and diabetic retinopathy (DR) patients, to assist in disease prevention via early detection before the disease progresses to a "wet AMD" pathology or diabetic macular edema (DME), requiring treatment. We propose a proof-of-concept AI-based app to help predict fluid via a "fluid score", prevent fluid progression, and provide personalized, serial monitoring, in the context of predictive, preventive, and personalized medicine (PPPM) for patients at risk of retinal fluid complications. Methods The app comprises a convolutional neural network-Vision Transformer (CNN-ViT)-based segmentation deep learning (DL) network, trained on a small dataset of 100 training images (augmented to 992 images) from the Singapore Epidemiology of Eye Diseases (SEED) study, together with a CNN-based classification network trained on 8497 images, that can detect fluid vs. non-fluid optical coherence tomography (OCT) scans. Both networks are validated on external datasets. Results Internal testing for our segmentation network produced an IoU score of 83.0% (95% CI = 76.7-89.3%) and a DICE score of 90.4% (86.3-94.4%); for external testing, we obtained an IoU score of 66.7% (63.5-70.0%) and a DICE score of 78.7% (76.0-81.4%). Internal testing of our classification network produced an area under the receiver operating characteristics curve (AUC) of 99.18%, and a Youden index threshold of 0.3806; for external testing, we obtained an AUC of 94.55%, and an accuracy of 94.98% and an F1 score of 85.73% with Youden index. Conclusion We have developed an AI-based app with an alternative transformer-based segmentation algorithm that could potentially be applied in the clinic with a PPPM approach for serial monitoring, and could allow for the generation of retrospective data to research into the varied use of treatments for AMD and DR. The modular system of our app can be scaled to add more iterative features based on user feedback for more efficient monitoring. Further study and scaling up of the algorithm dataset could potentially boost its usability in a real-world clinical setting. Supplementary information The online version contains supplementary material available at 10.1007/s13167-022-00301-5.
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Affiliation(s)
- Ten Cheer Quek
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Rd, Level 6 Discovery Tower, Singapore, 169856 Singapore
| | | | - Hyun Goo Kang
- Department of Ophthalmology, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sahil Thakur
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Rd, Level 6 Discovery Tower, Singapore, 169856 Singapore
| | - Mihir Deshmukh
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Rd, Level 6 Discovery Tower, Singapore, 169856 Singapore
| | - Rachel Marjorie Wei Wen Tseng
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Rd, Level 6 Discovery Tower, Singapore, 169856 Singapore
| | - Helen Nguyen
- Department of Ophthalmology, Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
- School of Optometry and Vision Science, Faculty of Science, The University of New South Wales, Sydney, NSW Australia
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Rd, Level 6 Discovery Tower, Singapore, 169856 Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Tyler Hyungtaek Rim
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Rd, Level 6 Discovery Tower, Singapore, 169856 Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore
- Medi Whale Inc, Seoul, South Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yasuo Yanagi
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Rd, Level 6 Discovery Tower, Singapore, 169856 Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology and Microtechnology, Yokohama City University, Yokohama, Japan
| | - Gerald Liew
- Department of Ophthalmology, Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Rd, Level 6 Discovery Tower, Singapore, 169856 Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
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15
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Allen DW, Liew G, Cho YH, Pryke A, Cusumano J, Hing S, Chan AK, Craig ME, Donaghue KC. Thirty-Year Time Trends in Diabetic Retinopathy and Macular Edema in Youth With Type 1 Diabetes. Diabetes Care 2022; 45:2247-2254. [PMID: 35594057 DOI: 10.2337/dc21-1652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 03/18/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine trends in diabetic retinopathy (DR) and diabetic macular edema (DME) in adolescents with type 1 diabetes between 1990 and 2019. RESEARCH DESIGN AND METHODS We analyzed 5,487 complication assessments for 2,404 adolescents (52.7% female, aged 12-20 years, diabetes duration >5 years), stratified by three decades (1990-1999, 2000-2009, 2010-2019). DR and DME were graded according to the modified Airlie House classification from seven-field stereoscopic fundal photography. RESULTS Over three decades, the prevalence of DR was 40, 21, and 20% (P < 0.001) and DME 1.4, 0.5, and 0.9% (P = 0.13), respectively, for 1990-1999, 2000-2009, and 2010-2019. Continuous subcutaneous insulin infusion (CSII) use increased (0, 12, and 55%; P < 0.001); mean HbA1c was bimodal (8.7, 8.5, and 8.7%; P < 0.001), and the proportion of adolescents meeting target HbA1c <7% did not change significantly (8.3, 7.7, and 7.1%; P = 0.63). In multivariable generalized estimating equation analysis, DR was associated with 1-2 daily injections (odds ratio 1.88, 95% CI 1.42-2.48) and multiple injections in comparison with CSII (1.38, 1.09-1.74); older age (1.11, 1.07-1.15), higher HbA1c (1.19, 1.05-1.15), longer diabetes duration (1.15, 1.12-1.18), overweight/obesity (1.27, 1.08-1.49) and higher diastolic blood pressure SDS (1.11, 1.01-1.21). DME was associated with 1-2 daily injections (3.26, 1.72-6.19), longer diabetes duration (1.26, 1.12-1.41), higher diastolic blood pressure SDS (1.66, 1.22-2.27), higher HbA1c (1.28, 1.03-1.59), and elevated cholesterol (3.78, 1.84-7.76). CONCLUSIONS One in five adolescents with type 1 diabetes had DR in the last decade. These findings support contemporary guidelines for lower glycemic targets, increasing CSII use, and targeting modifiable risk factors including blood pressure, cholesterol, and overweight/obesity.
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Affiliation(s)
- Digby W Allen
- School of Medicine, University of New South Wales, Kensington, Australia
| | - Gerald Liew
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.,Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Yoon Hi Cho
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia
| | - Alison Pryke
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Janine Cusumano
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Stephen Hing
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Albert K Chan
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia
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16
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Januszewski AS, Velayutham V, Benitez-Aguirre PZ, Craig ME, Cusumano J, Pryke A, Hing S, Liew G, Cho YH, Chew EY, Jenkins AJ, Donaghue KC. Optimal Frequency of Retinopathy Screening in Adolescents With Type 1 Diabetes: Markov Modeling Approach Based on 30 Years of Data. Diabetes Care 2022; 45:2383-2390. [PMID: 35975939 PMCID: PMC9643143 DOI: 10.2337/dc22-0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/27/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Current guidelines recommend biennial diabetic retinopathy (DR) screening commencing at the age of 11 years and after 2-5 years' duration of type 1 diabetes. Growing evidence suggests less frequent screening may be feasible. RESEARCH DESIGN AND METHODS Prospective data were collected from 2,063 youth with type 1 diabetes who were screened two or more times between 1990 and 2019. Baseline (mean ± SD) age was 13.3 ± 1.8 years, HbA1c was 8.6 ± 1.3% (70.1 ± 14.7 mmol/mol), diabetes duration was 5.6 ± 2.8 years, and follow-up time was 4.8 ± 2.8 years. DR was manually graded from 7-field retinal photographs using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Markov chain was used to calculate probabilities of DR change over time and hazard ratio (HR) of DR stage transition. RESULTS The incidence of moderate nonproliferative DR (MNPDR) or worse was 8.6 per 1,000 patient-years. Probabilities of transition to this state after a 3-year interval were from no DR, 1.3%; from minimal DR, 5.1%; and from mild DR, 22.2%, respectively. HRs (95% CIs) for transition per 1% current HbA1c increase were 1.23 (1.16-1.31) from no DR to minimal NPDR, 1.12 (1.03-1.23) from minimal to mild NPDR, and 1.28 (1.13-1.46) from mild to MNPDR or worse. HbA1c alone explained 27% of the transitions between no retinopathy and MNPDR or worse. The addition of diabetes duration into the model increased this value to 31% (P = 0.03). Risk was also increased by female sex and higher attained age. CONCLUSIONS These results support less frequent DR screening in youth with type 1 diabetes without DR and short duration. Although DR progression to advanced stages is generally slow, higher HbA1c greatly accelerates it.
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Affiliation(s)
- Andrzej S. Januszewski
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Vallimayil Velayutham
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Paul Z. Benitez-Aguirre
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Maria E. Craig
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Janine Cusumano
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Alison Pryke
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Stephen Hing
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Gerald Liew
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Yoon Hi Cho
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Emily Y. Chew
- National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Alicia J. Jenkins
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Kim C. Donaghue
- Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
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17
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Velayutham V, Benitez-Aguirre P, Craig M, Cho YH, Liew G, Donaghue K. Cardiac Autonomic Nerve Dysfunction Predicts Incident Retinopathy and Early Kidney Dysfunction in Adolescents With Type 1 Diabetes. Diabetes Care 2022; 45:2391-2395. [PMID: 35997303 DOI: 10.2337/dc22-0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 07/10/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Cardiac autonomic neuropathy (CAN) may contribute to vascular complications in diabetes. We hypothesized that adolescents with CAN are at greater risk of diabetic retinopathy and early kidney dysfunction. RESEARCH DESIGN AND METHODS In this prospective longitudinal study of 725 adolescents with type 1 diabetes without retinopathy and albuminuria at baseline, early CAN was defined as one or more abnormalities in seven heart rate tests derived from a 10-min electrocardiogram. Retinopathy was defined as the presence of one or more microaneurysms, early kidney dysfunction as an albumin excretion rate (AER) >7.5 μg/min, and albuminuria as an AER >20 μg/min. Multivariable generalized estimating equations were used to examine the association between CAN and retinopathy or early kidney dysfunction. Cox proportional hazards regression analysis was used to assess cumulative risks of incident retinopathy and albuminuria. RESULTS At baseline, the mean age of the sample was 13.6 ± 2.6 years, 52% were male, and mean diabetes duration was 6.1 ± 3.3 years. Over a median follow-up of 3.8 (interquartile range 2.2-7.5) years, the complication rate 27% for retinopathy, 16% for early kidney dysfunction, and 3% for albuminuria. The mean study HbA1c was 72.3 ± 16 mmol/mmol (8.6 ± 1.4%). CAN predicted incident retinopathy (odds ratio 2.0 [95% CI 1.4, 2.9]) and early kidney dysfunction (1.4 [1.0, 2.0]) after adjusting for HbA1c and diabetes duration. CAN also predicted retinopathy (hazard ratio 1.57 [95% CI 1.09, 2.26]) and albuminuria (2.30 [1.05, 5.04]) independently of HbA1c. CONCLUSIONS CAN predicted incident retinopathy and kidney dysfunction in adolescents with type 1 diabetes, likely reflecting autonomic microvascular dysregulation contributing to complications. Therefore, screening and interventions to reduce CAN may influence the risk of complications.
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Affiliation(s)
- Vallimayil Velayutham
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.,Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Paul Benitez-Aguirre
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Maria Craig
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Yoon Hi Cho
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology, and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Kim Donaghue
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
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18
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Jeevakumar V, Sefton R, Chan J, Gopinath B, Liew G, Shah TM, Siette J. Association between retinal markers and cognition in older adults: a systematic review. BMJ Open 2022; 12:e054657. [PMID: 35728906 PMCID: PMC9214387 DOI: 10.1136/bmjopen-2021-054657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To appraise the existing literature reporting an association between retinal markers and cognitive impairment in adults aged 65 years and over and to provide directions for future use of retinal scanning as a potential tool for dementia diagnosis. DESIGN Systematic review of peer-reviewed empirical articles investigating the association of retinal markers in assessing cognitive impairment. DATA SOURCES Three electronic databases, Medline, PsycINFO and EMBASE were searched from inception until March 2022. ELIGIBILITY CRITERIA All empirical articles in English investigating the association between retinal markers and cognition in humans aged ≥65 years using various retinal scanning methodologies were included. Studies with no explicit evaluation of retinal scanning and cognitive outcomes were excluded. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. DATA EXTRACTION AND SYNTHESIS Data extraction was conducted by two authors (VJ, RS) and reviewed by another author (JS). Results were synthesised and described narratively. RESULTS Sixty-seven eligible studies examining 6815 older adults were included. Majority of studies were cross-sectional (n=60; 89.6%). Optical coherence tomography (OCT) was the most commonly used retinal scanning methodology to measure the thickness of retinal nerve fibre layer, the ganglion cell complex, choroid and macula. 51.1% of cross-sectional studies using OCT reported an association between the thinning of at least one retinal parameter and poor cognition. Longitudinal studies (n=6) using OCT also mostly identified significant reductions in retinal nerve fibre layer thickness with cognitive decline. Study quality was overall moderate. CONCLUSION Retinal nerve fibre layer thickness is linked with cognitive performance and therefore may have the potential to detect cognitive impairment in older adults. Further longitudinal studies are required to validate our synthesis and understand underlying mechanisms before recommending implementation of OCT as a dementia screening tool in clinical practice. PROSPERO REGISTRATION NUMBER CRD42020176757.
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Affiliation(s)
- Varshanie Jeevakumar
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Rebekah Sefton
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Joyce Chan
- New Look Eyewear, Maitland, New South Wales, Australia
| | - Bamini Gopinath
- Department of Linguistics, Australian Hearing Hub, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Gerald Liew
- Centre for Vision Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Tejal M Shah
- Macquarie Medical School, Macquarie University, North Ryde, New South Wales, Australia
| | - Joyce Siette
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, New South Wales, Australia
- MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, New South Wales, Australia
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19
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Singh AD, Raval V, Bellerive C, Gopinath B, Liew G, Mitchell P. Choroidal melanocytic lesions in children: focal aggregates and melanocytosis. J AAPOS 2021; 25:327.e1-327.e5. [PMID: 34728382 DOI: 10.1016/j.jaapos.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/25/2021] [Accepted: 07/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate prevalence and age of onset of choroidal melanocytic lesions (other than nevi) in pediatric patients. METHODS The pooled data of participants 6 months to 18 years of age in the Sydney Paediatric Eye Disease Study, the Sydney Myopia Study, and the Sydney Adolescent Vascular Eye Disease Study were reviewed retrospectively to identify children with choroidal melanocytic lesions. The clinical features and prevalence by age were assessed. RESULTS From the pooled sample of 5,533 unique children, 39 cases of focal melanocytic aggregates and 22 cases of choroidal melanocytosis were identified, with overall prevalence of 0.70% and 0.40%, respectively. There was a statistically significant trend toward increased prevalence with increasing age. Both focal melanocytic aggregates and choroidal melanocytosis tended to be bilateral (100% and 86% respectively), brown in color, and temporally located in all cases. Amelanotic variants were not identified. Focal melanocytic aggregates were small (0.15-0.5 mm), whereas choroidal melanocytosis varied in size (5.0-20 mm). All focal melanocytic aggregates were characteristically located 4-5 mm temporal to the center of the fovea and were associated with linear nervelike (11 [28%]) or tortuous vessel like structures (10 [26%]). CONCLUSIONS In this study, pooled data from large population studies revealed morphologic patterns of choroidal melanocytic lesions, other than nevus, that correlate with described clinical appearance in adults. The association of focal melanocytic aggregates with nervelike structures supports their embryologic origin along the migration path of uveal melanocytes.
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Affiliation(s)
- Arun D Singh
- Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Vishal Raval
- Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), The Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), The Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), The Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
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20
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Graves LE, Pryke AF, Cho YH, Cusumano JM, Craig ME, Liew G, Donaghue KC. Sight-threatening retinopathy in nine adolescents with early onset type 1 diabetes. Pediatr Diabetes 2021; 22:1129-1134. [PMID: 34536254 DOI: 10.1111/pedi.13265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 01/01/2023] Open
Abstract
In adults, there has been a decline in the incidence of diabetic retinopathy (DR) associated with improvements in diabetes management. Data on incident severe DR in adolescents are sparse. In our established diabetes complications assessment service, we recorded nine cases of sight-threatening retinopathy in youth aged 15-17.9 years from 2017 to 2021. Proliferative retinopathy and clinically significant macular oedema were identified. The subjects were diagnosed with type 1 diabetes before the age of 10 years and had a history of poor glycaemic control (HbA1c 86-130 mmol/mol, 10%-15%). Five cases of retinopathy developed rapidly within 2.5 years of a previously normal retinal examination on seven-field stereoscopic retinal photography. Three adolescents required laser photocoagulation therapy. Two adolescents were diagnosed with retinopathy following improvement in diabetes control after being lost to medical follow-up and their retinopathy improved with improved glycaemic control. Thus, we support repeated retinal screening in adolescents with diabetes duration >10 years with suboptimal glycaemic control, even when initial retinal examination is normal, as retinopathy can progress rapidly during adolescence.
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Affiliation(s)
- Lara E Graves
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia
| | - Alison F Pryke
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia
| | - Yoon Hi Cho
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia
| | - Janine M Cusumano
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Gerald Liew
- Centre for Vision Research, Westmead Institute for Medical Research, Department of Ophthalmology, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,Children's Hospital Westmead Clinical School, University of Sydney, Sydney, Australia
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Velayutham V, Benitez-Aguirre PZ, Liew G, Wong TY, Jenkins AJ, Craig ME, Donaghue KC. Baseline extended zone retinal vascular calibres associate with sensory nerve abnormalities in adolescents with type 1 diabetes: A prospective longitudinal study. Diabet Med 2021; 38:e14662. [PMID: 34324736 DOI: 10.1111/dme.14662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The relationship between retinal vascular calibres (RVCs) and diabetic neuropathy is unclear. We investigated associations between RVCs and sensory nerve abnormality in adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS In a prospective longitudinal study of 889 adolescents with type 1 diabetes with baseline mean (±SD) age 14.1 ± 1.5 years and HbA1c IFCC 69.4 ± 14.1 mmol/mol (8.6 ± 1.3%), RVCs were assessed from baseline retinal photographs: 'central zone' calibres, summarized as central retinal arteriolar (CRAE) and venular equivalents (CRVE) and 'extended zone' calibres: mean width of arterioles (MWa) and venules (MWv). Sensory nerve abnormality was defined as at least one abnormal sensory quantitative testing from two thermal and two vibration threshold tests measured at foot every 1-2 years. Associations between baseline RVC and sensory nerve function were examined using generalized estimating equations and cumulative risk by Cox regression analyses. RESULTS During a median study follow-up of 6.2 [IQR 3.7-10.4] years, sensory nerve abnormality was found in 27% of adolescents. Narrower extended zone calibre quartiles but not CRAE or CRVE quartiles were independently associated with sensory nerve abnormality: MWa (Q1 vs. Q2-4: OR 1.35 (95% CI 1.02, 1.61) and MWv (Q1 vs. Q2-4: 1.31 (1.03, 1.7)), after adjusting for HbA1c , duration and blood pressure. Similarly, in Cox regression, the narrowest quartiles were associated with sensory nerve abnormality: MWa hazard ratio (HR) 1.5 (1.3, 1.8) and MWv 1.6 (1.4, 1.9). CONCLUSIONS Narrower extended zone retinal calibres were associated with sensory nerve abnormality in adolescents with type 1 diabetes and may present useful biomarkers to understand the pathophysiology of neuropathy.
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Affiliation(s)
- Vallimayil Velayutham
- The Children's Hospital at Westmead, Westmead, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Campbelltown Hospital, Campbelltown, NSW, Australia
| | - Paul Z Benitez-Aguirre
- The Children's Hospital at Westmead, Westmead, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Gerald Liew
- The Children's Hospital at Westmead, Westmead, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Maria E Craig
- The Children's Hospital at Westmead, Westmead, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Kim C Donaghue
- The Children's Hospital at Westmead, Westmead, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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22
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Jin I, Tang D, Gengaroli J, Nicholson Perry K, Burlutsky G, Craig A, Liew G, Mitchell P, Gopinath B. Cross-sectional study evaluating burden and depressive symptoms in family carers of persons with age-related macular degeneration in Australia. BMJ Open 2021; 11:e048658. [PMID: 34497082 PMCID: PMC8438959 DOI: 10.1136/bmjopen-2021-048658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES We aimed to analyse the degree of carer burden and depressive symptoms in family carers of persons with age-related macular degeneration (AMD) and explore the factors independently associated with carer burden and depressive symptoms. METHODS Cross-sectional study using self-administered and interviewer-administered surveys, involving 96 family carer-care recipient pairs. Participants were identified from tertiary ophthalmology clinics in Sydney, Australia, as well as the Macular Disease Foundation of Australia database. Logistic regression, Pearson and Spearman correlation analyses were used to investigate associations of explanatory factors (family caregiving experience, carer fatigue, carer quality of life and care-recipient level of dependency) with study outcomes-carer burden and depressive symptoms. RESULTS Over one in two family carers reported experiencing mild or moderate-severe burden. More than one in five and more than one in three family carers experienced depressive symptoms and substantial fatigue, respectively. High level of care-recipient dependency was associated with greater odds of moderate-severe and mild carer burden, multivariable-adjusted OR 8.42 (95% CI 1.88 to 37.60) and OR 4.26 (95% CI 1.35 to 13.43), respectively. High levels of fatigue were associated with threefold greater odds of the carer experiencing depressive symptoms, multivariable-adjusted OR 3.47 (95% CI 1.00 to 12.05). CONCLUSIONS A substantial degree of morbidity is observed in family carers during the caregiving experience for patients with AMD. Level of dependency on the family carer and fatigue were independently associated with family carer burden and depressive symptoms. TRIAL REGISTRATION NUMBER The trial registration number is ACTRN12616001461482. The results presented in this paper are Pre-results stage.
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Affiliation(s)
- Ivan Jin
- Centre for Vision Research, University of Sydney, Sydney, New South Wales, Australia
| | - Diana Tang
- Macquarie University Hearing, Macquarie University, Sydney, New South Wales, Australia
| | - Jessica Gengaroli
- Discipline of Psychological Science, Australian College of Applied Psychology, Sydney, New South Wales, Australia
| | - Kathryn Nicholson Perry
- Discipline of Psychological Science, Australian College of Applied Psychology, Sydney, New South Wales, Australia
| | - George Burlutsky
- Macquarie University Hearing, Macquarie University, Sydney, New South Wales, Australia
| | - Ashley Craig
- Northern Clinical School, University of Sydney, St Leonards, New South Wales, Australia
| | - Gerald Liew
- Centre for Vision Research, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Mitchell
- Centre for Vision Research, University of Sydney, Sydney, New South Wales, Australia
| | - Bamini Gopinath
- Macquarie University Hearing, Macquarie University, Sydney, New South Wales, Australia
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23
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Gyawali R, Toomey M, Stapleton F, Zangerl B, Dillon L, Ho KC, Keay L, Alkhawajah SMM, Liew G, Jalbert I. Systematic review of diabetic eye disease practice guidelines: more applicability, transparency and development rigor are needed. J Clin Epidemiol 2021; 140:56-68. [PMID: 34487836 DOI: 10.1016/j.jclinepi.2021.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/09/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess the quality of diabetic eye disease clinical practice guidelines. STUDY DESIGN AND SETTING A systematic search of diabetic eye disease guidelines was conducted on six online databases and guideline repositories. Four reviewers independently rated quality using the Appraisal of Guidelines, Research, and Evaluation (AGREE II) instrument. Aggregate scores (%) for six domains and overall quality assessment were calculated. A "good quality" guideline was one with ≥60% score for "rigor of development" and in at least two other domains. RESULTS Eighteen guidelines met the inclusion criteria, of which 13 were evidence-based guidelines (involved systematic search and grading of evidence). The median scores (interquartile range (IQR)) for "scope and purpose," "stakeholder involvement," "rigor of development," "clarity of presentation," "applicability" and "editorial independence" were 73.6% (54.2%-80.6%), 48.6% (29.2%-71.5%), 60.2% (30.9%-78.1%), 86.6% (76.7%-94.4%), 28.6% (18.0%-37.8%) and 60.2% (30.9%-78.1%), respectively. The median overall score (out of 7) of all guidelines was 5.1 (IQR: 3.7-5.8). Evidence-based guidelines scored significantly higher compared to expert-consensus guidelines. Half (n = 9) of the guidelines (all evidence-based) were of "good quality." CONCLUSION A wide variation in methodological quality exists among diabetic eyecare guidelines, with nine demonstrating "good quality." Future iterations of guidelines could improve by appropriately engaging stakeholders, following a rigorous development process, including support for application in clinical practice and ensuring editorial transparency.
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Affiliation(s)
- Rajendra Gyawali
- School of Optometry and Vision Science, UNSW Sydney, Australia; Better Vision Foundation Nepal, Kathmandu, Nepal.
| | - Melinda Toomey
- School of Optometry and Vision Science, UNSW Sydney, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science, UNSW Sydney, Australia
| | - Lisa Dillon
- School of Optometry and Vision Science, UNSW Sydney, Australia; The George Institute for Global Health, Sydney, Australia
| | - Kam Chun Ho
- School of Optometry and Vision Science, UNSW Sydney, Australia; The George Institute for Global Health, Sydney, Australia; Singapore Eye Research Institute, Singapore
| | - Lisa Keay
- School of Optometry and Vision Science, UNSW Sydney, Australia; The George Institute for Global Health, Sydney, Australia
| | - Sally Marwan M Alkhawajah
- School of Optometry and Vision Science, UNSW Sydney, Australia; Department of Optometry and Vision Science, King Saud University, Riyadh, Saudi Arabia
| | - Gerald Liew
- Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
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24
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Tang F, Wang X, Ran AR, Chan CKM, Ho M, Yip W, Young AL, Lok J, Szeto S, Chan J, Yip F, Wong R, Tang Z, Yang D, Ng DS, Chen LJ, Brelén M, Chu V, Li K, Lai THT, Tan GS, Ting DSW, Huang H, Chen H, Ma JH, Tang S, Leng T, Kakavand S, Mannil SS, Chang RT, Liew G, Gopinath B, Lai TYY, Pang CP, Scanlon PH, Wong TY, Tham CC, Chen H, Heng PA, Cheung CY. A Multitask Deep-Learning System to Classify Diabetic Macular Edema for Different Optical Coherence Tomography Devices: A Multicenter Analysis. Diabetes Care 2021; 44:2078-2088. [PMID: 34315698 PMCID: PMC8740924 DOI: 10.2337/dc20-3064] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/29/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetic macular edema (DME) is the primary cause of vision loss among individuals with diabetes mellitus (DM). We developed, validated, and tested a deep learning (DL) system for classifying DME using images from three common commercially available optical coherence tomography (OCT) devices. RESEARCH DESIGN AND METHODS We trained and validated two versions of a multitask convolution neural network (CNN) to classify DME (center-involved DME [CI-DME], non-CI-DME, or absence of DME) using three-dimensional (3D) volume scans and 2D B-scans, respectively. For both 3D and 2D CNNs, we used the residual network (ResNet) as the backbone. For the 3D CNN, we used a 3D version of ResNet-34 with the last fully connected layer removed as the feature extraction module. A total of 73,746 OCT images were used for training and primary validation. External testing was performed using 26,981 images across seven independent data sets from Singapore, Hong Kong, the U.S., China, and Australia. RESULTS In classifying the presence or absence of DME, the DL system achieved area under the receiver operating characteristic curves (AUROCs) of 0.937 (95% CI 0.920-0.954), 0.958 (0.930-0.977), and 0.965 (0.948-0.977) for the primary data set obtained from CIRRUS, SPECTRALIS, and Triton OCTs, respectively, in addition to AUROCs >0.906 for the external data sets. For further classification of the CI-DME and non-CI-DME subgroups, the AUROCs were 0.968 (0.940-0.995), 0.951 (0.898-0.982), and 0.975 (0.947-0.991) for the primary data set and >0.894 for the external data sets. CONCLUSIONS We demonstrated excellent performance with a DL system for the automated classification of DME, highlighting its potential as a promising second-line screening tool for patients with DM, which may potentially create a more effective triaging mechanism to eye clinics.
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Affiliation(s)
- Fangyao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Xi Wang
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong SAR
| | - An-Ran Ran
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | | | - Mary Ho
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR.,Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
| | - Wilson Yip
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR.,Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR.,Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
| | - Jerry Lok
- Hong Kong Eye Hospital, Hong Kong SAR
| | | | | | - Fanny Yip
- Hong Kong Eye Hospital, Hong Kong SAR
| | | | - Ziqi Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Danny S Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR.,Hong Kong Eye Hospital, Hong Kong SAR
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR
| | - Marten Brelén
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Victor Chu
- United Christian Hospital, Hong Kong SAR
| | - Kenneth Li
- United Christian Hospital, Hong Kong SAR
| | | | - Gavin S Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Daniel S W Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Haifan Huang
- Joint Shantou International Eye Center, Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Haoyu Chen
- Joint Shantou International Eye Center, Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Jacey Hongjie Ma
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China
| | - Shibo Tang
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China
| | - Theodore Leng
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA
| | - Schahrouz Kakavand
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA
| | - Suria S Mannil
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA
| | - Robert T Chang
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA
| | - Gerald Liew
- Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Bamini Gopinath
- Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia.,Macquarie University Hearing, Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Peter H Scanlon
- Gloucestershire Retinal Research Group, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, U.K
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR.,Hong Kong Eye Hospital, Hong Kong SAR.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR
| | - Hao Chen
- Department of Computer Science and Engineering, The Hong Kong University of Sciences and Technology, Hong Kong SAR
| | - Pheng-Ann Heng
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong SAR
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
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25
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Raval V, Bellerive C, Singh AD, Gopinath B, Liew G, Mitchell P. Choroidal nevi in children: prevalence, age of onset, and progression. J AAPOS 2021; 25:225.e1-225.e6. [PMID: 34271212 DOI: 10.1016/j.jaapos.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the age of onset and prevalence of choroidal nevi in children. METHODS In this cross-sectional study, the fundus photographs of a pooled sample of children 6 months to 18 years of age with 6-year longitudinal follow-up who participated in the Sydney Paediatric Eye Disease Study, Sydney Myopia Study, and the Sydney Adolescent Vascular Eye Disease Study were reviewed. Prevalence by age, clinical features, and longitudinal follow-up assessment was undertaken. RESULTS Of 5,533 children (7,059 examinations), 48 children with a choroidal nevus were identified. Prevalence increased with age: <6 years, 0.47%; 6 years, 0.63%; 12 years, 1.06%; 18 years, 1.79%. Nevus was unilateral in all cases (100%), and the majority were melanotic (46, 96%). Most (36 [75%]) were irregular in shape, with ill-defined margins (45 [94%]). All identified nevi were posterior to the equator. All nevi were small, with the average largest basal diameter of 1.6 mm (range, 0.5-3.2) and were not associated with secondary changes (drusen, orange pigment, subretinal fluid). The majority (18/31 [58%]) of nevi remained stable, with 5 of 31 (16%) demonstrating subtle growth (minimum of 600 μm). Four new-onset nevi were documented. Malignant transformation was not observed in any of the nevi. CONCLUSIONS In our study cohort, the prevalence of choroidal nevi increased with age up to 18 years. The distribution and prevalence of choroidal melanocytic lesions reported herein can be used for designing population-based studies in children that incorporate emerging imaging technologies.
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Affiliation(s)
- Vishal Raval
- Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland
| | | | - Arun D Singh
- Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland.
| | - Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), The Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), The Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), The Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
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26
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Liew G, Nguyen H, Ho IV, White AJ, Burlutsky G, Gopinath B, Mitchell P. Prevalence of Vitreoretinal Interface Disorders in an Australian Population. Ophthalmology Science 2021; 1:100019. [PMID: 36249297 PMCID: PMC9560650 DOI: 10.1016/j.xops.2021.100019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/05/2021] [Accepted: 04/05/2021] [Indexed: 11/27/2022]
Abstract
Purpose To describe the prevalence, risk factors, and associations of vitreoretinal interface (VRI) abnormalities in a population-based study of older adults. Design Cross-sectional analysis of cohort study participants. Participants Of the 1149 participants (mean age, 76.1 ± 6.9 years) in the 15-year Blue Mountains Eye Study follow-up examination from 2007 through 2009, 905 (1791 eyes) had gradable time-domain or spectral-domain OCT scans of the macula from at least 1 eye. Methods OCT scans were graded according to the International Vitreomacular Traction Study Group classification system of VRI abnormalities. Best-corrected visual acuity (BCVA) was recorded. Main Outcome Measures Prevalence of VRIs. Results Overall, 451 participants showed any VRI abnormality (49.8%). Prevalence of VRI abnormality by person was: vitreomacular adhesion (VMA), 33.6%; vitreomacular traction (VMT), 1.6%; epiretinal membrane (ERM), 21.4%; full-thickness macular hole (FTMH), 0.7%; and lamellar macular hole (LMH), 0.7%. Twenty-two percent of VMAs were focal, and 78% were broad based; 76% of VMTs were focal, and 24% were broad based. All FTMHs observed were large (>400 μm), with mean aperture size of 573 μm (range, 459–771 μm). Increased age was associated with higher ERM and lower VMA prevalence (P < 0.001 for both). Pseudophakia and myopia were associated with ERM (age- and sex-adjusted odds ratios [ORs], 1.48 [95% confidence interval (CI), 1.01–2.17] and 1.72 [95% CI, 1.05–2.81], respectively). Moderate or severe ERM and FTMH were associated with worse BCVA of 9.2 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (95% CI, 3.4–15.0 ETDRS letters; P = 0.008) and 26.0 ETDRS letters (95% CI, 10.9–41.1 ETDRS letters; P = 0.001), respectively. Conclusions The prevalence of VRI abnormalities is high in older individuals. Epiretinal membrane was associated with increasing age, pseudophakia, and myopia. Epiretinal membrane and FTMH may account for significant visual loss in the affected eye. This study provided useful population-based data on the prevalence of VRI abnormalities in older individuals.
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Affiliation(s)
- Gerald Liew
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
- South West Retina, Retina Associates, Sydney, Australia
- Corresponding author: Gerald Liew, MD, PhD, Centre for Vision Research, The Westmead Institute for Medical Research, University of Sydney, Westmead Hospital, 176 Hawkesbury Road, Westmead, NSW Australia, 2145.
| | - Helen Nguyen
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - I-Van Ho
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
- South West Retina, Retina Associates, Sydney, Australia
- Macquarie University, Department of Ophthalmology, Macquarie Park, Sydney, Australia
| | - Andrew J. White
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - George Burlutsky
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Bamini Gopinath
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
- Macquarie University, Department of Ophthalmology, Macquarie Park, Sydney, Australia
| | - Paul Mitchell
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
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27
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Vu KV, Mitchell P, Dharamdasani Detaram H, Burlutsky G, Liew G, Gopinath B. Prevalence and risk factors for depressive symptoms in patients with neovascular age-related macular degeneration who present for anti-VEGF therapy. Acta Ophthalmol 2021; 99:e547-e554. [PMID: 32981226 DOI: 10.1111/aos.14635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/27/2020] [Accepted: 09/06/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE To examine the prevalence and risk factors for depressive symptoms in patients with neovascular age-related macular degeneration (nAMD) presenting for anti-vascular endothelial growth factor (anti-VEGF) therapy. METHODS In a clinic-based cohort of 547 patients with nAMD who presented for treatment, the Centre of Epidemiological Studies Depression 10-point scale (CES-D-10) and Mental Health Index (MHI) component of the 36-item Short Form Survey were administered to assess for the presence of depressive symptoms. Logistic regression analyses were used to calculate odds ratios and 95% confidence intervals for factors associated with an increased likelihood of depressive symptoms. RESULTS The prevalence of depressive symptoms was 42.04% and 31.78% as per the CES-D-10 and MHI scales, respectively. Poor self-rated health (SRH) is associated with increased odds of depressive symptoms [multivariable-adjusted OR: 3.00 (95% CI 1.90-4.73) for CES-D-10; OR: 2.67 (95% CI 1.67-4.28) for MHI]. Impaired activities of daily living (ADLs) [multivariable-adjusted OR: 2.62 (95% CI 1.56-4.38) for CES-D-10; OR: 3.59 (95% CI 2.10-6.15) for MHI] and a visual function score within the two lowest quartiles were also associated with increased odds of depressive symptoms using both scales. CONCLUSION A high prevalence of depressive symptoms was observed among nAMD patients presenting for treatment. Poorer SRH, ADL impairment and reduced visual function were associated with increased odds of depressive symptoms.
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Affiliation(s)
- Kim Van Vu
- Centre for Vision Research The Westmead Institute for Medical Research The University of Sydney Sydney Australia
| | - Paul Mitchell
- Centre for Vision Research The Westmead Institute for Medical Research The University of Sydney Sydney Australia
| | - Harshil Dharamdasani Detaram
- Centre for Vision Research The Westmead Institute for Medical Research The University of Sydney Sydney Australia
| | - George Burlutsky
- Centre for Vision Research The Westmead Institute for Medical Research The University of Sydney Sydney Australia
| | - Gerald Liew
- Centre for Vision Research The Westmead Institute for Medical Research The University of Sydney Sydney Australia
| | - Bamini Gopinath
- Centre for Vision Research The Westmead Institute for Medical Research The University of Sydney Sydney Australia
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28
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Chaudhry SG, Liew G, Fung AT. Missing Internal Limiting Membrane during Macular Hole Repair in Alport Syndrome. Case Rep Ophthalmol 2021; 12:320-323. [PMID: 34054478 PMCID: PMC8136316 DOI: 10.1159/000513420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/27/2020] [Indexed: 11/19/2022] Open
Abstract
The aim of this manuscript is to describe a novel retinal finding of Alport syndrome during surgical management of an associated macular hole. A retrospective chart review of a 65-year-old man with a diagnosis of Alport syndrome confirmed by renal biopsy was found to have an associated full-thickness macular hole. Pars-plana vitrectomy surgery with internal limiting membrane (ILM) peeling was attempted, but intraoperatively the ILM was found to be absent at the macula. Alport syndrome may be associated with the absence of the ILM. This can complicate attempts at macular hole repair.
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Affiliation(s)
| | - Gerald Liew
- Westmead Hospital, Sydney, New South Wales, Australia.,Westmead and Central Clinical Schools, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Westmead Institute of Medical Research, Westmead, New South Wales, Australia.,Faculty of Medicine and Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Adrian T Fung
- Westmead Hospital, Sydney, New South Wales, Australia.,Westmead and Central Clinical Schools, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Westmead Institute of Medical Research, Westmead, New South Wales, Australia.,Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Gyawali R, Toomey M, Stapleton F, Zangerl B, Dillon L, Keay L, Liew G, Jalbert I. Quality of the Australian National Health and Medical Research Council's clinical practice guidelines for the management of diabetic retinopathy. Clin Exp Optom 2021; 104:864-870. [PMID: 33689646 DOI: 10.1080/08164622.2021.1880862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Clinical relevance: Understanding the quality of the commonly used clinical practice guidelines can help busy clinicians in selecting appropriate guidelines for evidence-based eye care for people with diabetes.Background: The National Health and Medical Research Council's (NHMRC) clinical practice guideline on diabetic retinopathy management has been widely used locally and internationally for over 10 years. However, the quality of this guideline has never been formally assessed. This study aimed to systematically evaluate the quality of the NHMRC guideline and compare it against other international guidelines.Methods: The 2008 NHMRC and another five established diabetic retinopathy management international guidelines (Scottish Intercollegiate Guidelines Network, 2017; American Academy of Ophthalmology, 2019; American Optometric Association, 2019; Royal College of Ophthalmologists, UK, 2013, and Canadian Ophthalmologic Society, 2012) were examined using the Appraisal of Guidelines, Research and Evaluation (AGREE II) instrument. Scoring by four independent reviewers was aggregated into six domain and overall rating scores. Consistency among the reviewers was assessed using intraclass correlation coefficient (ICC).Results: The AGREE II domain scores for the NHMRC guideline were: scope and purpose 72%, stakeholder involvement 64%, rigour of development 77%, clarity of presentation 96%, applicability 35%, and editorial independence 15%. The NHMRC guideline's overall score (5.3 of 7) was lower than that of most other guidelines. Compared to others, the NHMRC guideline scored well in clarity of presentation and rigour of development, but less well for editorial independence. The NHMRC guideline was the least current and a need to update it was recognised by all reviewers who identified key areas for improvement.Conclusion: The quality of the NHMRC guideline was comparable to most other established international guidelines. Several areas of strengths and weaknesses in this guideline were identified. Future updates should aim to improve transparency in development and applicability in clinical practice.
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Affiliation(s)
- Rajendra Gyawali
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Melinda Toomey
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Lisa Dillon
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Injury Division, The George Institute for Global Health, Sydney, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Injury Division, The George Institute for Global Health, Sydney, Australia
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology and the Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Abstract
BACKGROUND AND PURPOSE Fractal analysis is a method of quantifying the branching complexity and density of the retinal vessels. We hypothesized that reduced fractal dimension, signifying a sparser vascular network, is associated with long-term stroke mortality. METHODS We examined the relationship of fractal dimension and stroke mortality in a prospective, population-based cohort of 3143 participants aged 49 years or older. Fractal dimension was measured from digitized fundus photographs using a computer-automated method. Stroke mortality was documented from Australian National Death Index records. We defined reduced fractal dimension as values in the lowest quartile. RESULTS Over 12 years, there were 132 (4.2%) stroke-related deaths. Stroke-related mortality was higher in participants with reduced fractal dimension (lowest quartile) compared with the highest quartile (7.7% versus 1.3%, P<0.01). After controlling for age, gender, smoking, blood pressure, history of stroke, and other factors, participants with reduced fractal dimension had higher stroke mortality (hazard ratio, 2.42 [95% CI, 1.15-5.07], lowest versus highest quartile). When modeled as a continuous variable, reduced fractal dimension was associated with increased stroke mortality (multivariable-adjusted hazard ratio, 1.26 [95% CI, 1.06-1.51], per SD decrease). CONCLUSIONS Reduced retinal vascular fractal dimension is independently associated with 12-year stroke mortality. Reduced fractal dimension may indicate cerebral tissue hypoxia and increased risk of stroke.
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Affiliation(s)
- Gerald Liew
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Australia (G.L., B.G., A.J.W., G.B.M., P.M.)
| | - Bamini Gopinath
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Australia (G.L., B.G., A.J.W., G.B.M., P.M.)
| | - Andrew J White
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Australia (G.L., B.G., A.J.W., G.B.M., P.M.)
| | - George Burlutsky
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Australia (G.L., B.G., A.J.W., G.B.M., P.M.)
| | - Tien Yin Wong
- Duke-NUS Medical School, National University of Singapore (T.Y.W.).,Singapore Eye Research Institute, Singapore National Eye Center (T.Y.W.)
| | - Paul Mitchell
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Australia (G.L., B.G., A.J.W., G.B.M., P.M.)
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Dillon L, Gandhi S, Tang D, Liew G, Hackett M, Craig A, Mitchell P, Keay L, Gopinath B. Perspectives of people with late age‐related macular degeneration on mental health and mental wellbeing programmes: a qualitative study. Ophthalmic Physiol Opt 2021; 41:255-265. [DOI: 10.1111/opo.12779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Lisa Dillon
- School of Optometry and Vision Science University of New South Wales Sydney Kensington Australia
- Faculty of Medicine The George Institute for Global Health The University of New South Wales Sydney The Newtown Australia
| | - Sarthak Gandhi
- Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Australia
- Faculty of Medicine and Health The University of Sydney Sydney Australia
| | - Diana Tang
- Centre for Vision Research Department of Ophthalmology The Westmead Institute for Medical Research The University of Sydney Sydney Australia
| | - Gerald Liew
- Centre for Vision Research Department of Ophthalmology The Westmead Institute for Medical Research The University of Sydney Sydney Australia
| | - Maree Hackett
- Faculty of Medicine The George Institute for Global Health The University of New South Wales Sydney The Newtown Australia
- Faculty of Health and Wellbeing University of Central Lancashire Preston United Kingdom
| | - Ashley Craig
- John Walsh Centre for Rehabilitation Research Northern Clinical School Faculty of Medicine and Health The University of Sydney St. Leonards Australia
| | - Paul Mitchell
- Centre for Vision Research Department of Ophthalmology The Westmead Institute for Medical Research The University of Sydney Sydney Australia
| | - Lisa Keay
- School of Optometry and Vision Science University of New South Wales Sydney Kensington Australia
- Faculty of Medicine The George Institute for Global Health The University of New South Wales Sydney The Newtown Australia
| | - Bamini Gopinath
- Centre for Vision Research Department of Ophthalmology The Westmead Institute for Medical Research The University of Sydney Sydney Australia
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Liew G, Ho IV, Ong S, Gopinath B, Mitchell P. Efficacy of Topical Carbonic Anhydrase Inhibitors in Reducing Duration of Chronic Central Serous Chorioretinopathy. Transl Vis Sci Technol 2020; 9:6. [PMID: 33344050 PMCID: PMC7718817 DOI: 10.1167/tvst.9.13.6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Topical carbonic anhydrase inhibitors (CAIs) can influence retinal fluid distribution, but their role in treating central serous chorioretinopathy (CSCR) has not been studied. We examined the efficacy of a topical CAI (dorzolamide) in treating chronic CSCR. Methods Prospective, nonrandomized, controlled intervention study of patients with chronic CSCR of at least 3 months duration. Observed controls (n = 15) were recruited consecutively from 2016 to 2017; treated cases (n = 18) were recruited from 2018 to 2019. Controls were observed without active intervention, whereas treated cases were treated with topical dorzolamide for 3 months. The study end points were change in central macular thickness (CMT), change in best corrected visual acuity (BCVA), and proportion of eyes achieving complete resolution of subretinal fluid (SRF). All end points were at 3 months. Results Treated patients who received topical CAI had greater reduction in CMT (−145.6 µm, 95% confidence interval [CI] −170.5 to −120.7) compared to observed controls (−45.1 µm, 95% CI −65.3 to −25.1) at the main study end point of 3 months (P = 0.015). A higher proportion of treated patients achieved complete resolution of SRF compared to observed controls (77.8% vs. 40.0%, P = 0.04) at 3 months. However, change in BCVA at 3 months was similar in both groups (P = 0.12). Conclusions Topical CAI resulted in more rapid reduction of CMT compared to observation. These results, if confirmed in other studies, suggest topical CAI may be a viable treatment option for patients with chronic CSCR. Translational Relevance Topical CAI is used to treat a number of retinal disorders, and may be a novel treatment option for chronic CSCR.
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Affiliation(s)
- Gerald Liew
- Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), the Westmead Institute for Medical Research, University of Sydney, NSW, Australia.,Retina Associates, Sydney, NSW, Australia
| | - I-Van Ho
- Retina Associates, Sydney, NSW, Australia.,Retina Unit, Sydney Eye Hospital, Sydney, NSW, Australia
| | | | - Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), the Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), the Westmead Institute for Medical Research, University of Sydney, NSW, Australia.,Sydney West Retina, Sydney, NSW, Australia
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Velayutham V, Craig ME, Liew G, Wong TY, Jenkins AJ, Benitez-Aguirre PZ, Donaghue KC. Extended-Zone Retinal Vascular Caliber and Risk of Diabetic Retinopathy in Adolescents with Type 1 Diabetes. ACTA ACUST UNITED AC 2020; 4:1151-1157. [DOI: 10.1016/j.oret.2020.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/27/2020] [Accepted: 05/14/2020] [Indexed: 12/24/2022]
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Gopinath B, Liew G, Burlutsky G, McMahon CM, Mitchell P. Association between vision and hearing impairment and successful aging over five years. Maturitas 2020; 143:203-208. [PMID: 33308630 DOI: 10.1016/j.maturitas.2020.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 10/07/2020] [Accepted: 10/25/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We aimed to prospectively examine the relationship between vision and hearing loss and successful aging in a cohort of older adults. STUDY DESIGN We analyzed 5-year data (1997-9 to 2002-4) from 1,085 adults aged 55+ years, who were free of cancer, coronary artery disease and stroke at baseline and who had complete data on sensory loss. MAIN OUTCOME MEASURES Visual impairment was defined as visual acuity <20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold >25 dBHL (500-4000 Hz, better ear). Successful aging was defined as the absence of: disability, depressive symptoms, cognitive impairment, respiratory symptoms and chronic diseases (cancer, coronary artery disease and stroke) at 5-year follow-up. RESULTS At 5-year follow-up, 243 (22.4%) participants had died and 248 (22.9%) had aged successfully. After multivariable adjustment, participants who had either best-corrected visual impairment or bilateral hearing impairment, versus those who did not have sensory impairment at baseline, had 37% reduced odds of successful aging after 5 years: OR 0.63 (95% CI 0.43-0.94). Concurrent vision and hearing loss at baseline was not associated with 5-year aging status. Participants with moderate and severe hearing handicap at baseline had 50% and 61% reduced odds of aging successfully after 5 years, respectively. CONCLUSION The presence of a single sensory impairment in older adults was associated with reduced odds of being disease-free and fully functional or having aged successfully, 5 years later. Objectively measured hearing loss and self-perceived hearing handicap, rather than vision loss, was more likely to negatively influence 5-year aging status.
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Affiliation(s)
- Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, NSW, Australia; Department of Linguistics, Macquarie University, Sydney, NSW, Australia.
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - George Burlutsky
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | | | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, NSW, Australia
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Dharamdasani Detaram H, Liew G, Russell J, Vu KV, Burlutsky G, Mitchell P, Gopinath B. Dietary antioxidants are associated with presence of intra- and sub-retinal fluid in neovascular age-related macular degeneration after 1 year. Acta Ophthalmol 2020; 98:e814-e819. [PMID: 32162461 DOI: 10.1111/aos.14394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/20/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE To assess whether dietary intake of antioxidants, fruits, vegetables and fish is associated with 12-month treatment outcomes in neovascular age-related macular degeneration (nAMD) patients. METHODS A total of 547 participants were diagnosed with nAMD at baseline, of whom 494 were followed up after 12 months of antivascular endothelial growth factor therapy. Dietary intakes were determined using a validated food frequency questionnaire. Presence of intra-retinal and sub-retinal fluid (IRF, SRF), pigment epithelial detachment (PED) and central macular thickness (CMT) were recorded from optical coherence tomography images. Best-corrected visual acuity was recorded using log of the Minimum Angle of Resolution (LogMAR) charts. RESULTS Participants in the upper three quartiles combined compared to those in the first quartile of baseline dietary zinc intake had 49% reduced odds of SRF 12 months later, multivariable-adjusted odds ratio (OR) 0.51 [95% confidence interval (CI) 0.30-0.89]. The upper three quartiles combined compared to the first quartile of β-carotene intake had 90% greater odds of IRF presence at 12-month follow-up, multivariable-adjusted OR 1.90 (95% CI 1.04-3.46). The highest versus lowest quartile of dietary β-carotene intake had a nearly twofold greater odds of PED presence, multivariable-adjusted OR 1.99 (95% CI 1.03-3.84). CONCLUSION A higher intake of dietary zinc was associated with a reduced likelihood of SRF at 1 year. Conversely, a higher intake of dietary β-carotene was associated with an increased risk of IRF and PED. These findings underscore the importance of ongoing nutritional advice for nAMD patients presenting for treatment.
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Affiliation(s)
- Harshil Dharamdasani Detaram
- Centre for Vision Research Department of Ophthalmology and The Westmead Institute for Medical Research The University of Sydney Sydney New South Wales Australia
| | - Gerald Liew
- Centre for Vision Research Department of Ophthalmology and The Westmead Institute for Medical Research The University of Sydney Sydney New South Wales Australia
| | - Joanna Russell
- Faculty of Social Sciences School of Health and Society University of Wollongong Sydney New South Wales Australia
| | - Kim Van Vu
- Centre for Vision Research Department of Ophthalmology and The Westmead Institute for Medical Research The University of Sydney Sydney New South Wales Australia
| | - George Burlutsky
- Centre for Vision Research Department of Ophthalmology and The Westmead Institute for Medical Research The University of Sydney Sydney New South Wales Australia
| | - Paul Mitchell
- Centre for Vision Research Department of Ophthalmology and The Westmead Institute for Medical Research The University of Sydney Sydney New South Wales Australia
| | - Bamini Gopinath
- Centre for Vision Research Department of Ophthalmology and The Westmead Institute for Medical Research The University of Sydney Sydney New South Wales Australia
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Broadhead GK, Hong T, Bahrami B, Flood V, Liew G, Chang AA. Diet and risk of visual impairment: a review of dietary factors and risk of common causes of visual impairment. Nutr Rev 2020; 79:636-650. [PMID: 33051676 DOI: 10.1093/nutrit/nuaa100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Age-related macular degeneration, diabetic retinopathy, cataract, and glaucoma remain the leading causes of visual impairment in developed nations, resulting in a substantial treatment burden on sufferers and health care systems. Despite significant advances in diagnostic testing and therapeutics, population-based strategies to reduce the burden of these diseases remain limited. However, there is some evidence that these diseases may share overlapping risk factors, particularly in regard to dietary intake and antioxidant status, and it is thus possible that dietary modification may reduce both the prevalence and severity of these conditions. In particular, dietary intake of green leafy vegetables, hyperglycemia/glycemia index, and omega-3 fatty acid intake, as well as overall dietary patterns, may affect risk of one or more of these conditions. In this review, we analyse the evidence for dietary intake and the association with these conditions, and provide insights into possible modifications that may thus simultaneously reduce the risk of visual impairment from multiple causes, including improving dietary intake of green leafy vegetables and reducing dietary glycemic index, both of which have been associated with a decreased risk of multiple causes of visual impairment.
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Affiliation(s)
- Geoffrey K Broadhead
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia
| | - Thomas Hong
- Sydney Institute of Vision Science, Sydney, NSW, Australia
| | - Bobak Bahrami
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia
| | - Victoria Flood
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Western Sydney Local Health District, Sydney, NSW, Australia.,Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Gerald Liew
- Centre for Vision Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Andrew A Chang
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia
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Tang D, Mitchell P, Liew G, Burlutsky G, Flood VM, Gopinath B. Telephone-Delivered Dietary Intervention in Patients with Age-Related Macular Degeneration: 3-Month Post-Intervention Findings of a Randomised Controlled Trial. Nutrients 2020; 12:E3083. [PMID: 33050401 PMCID: PMC7650817 DOI: 10.3390/nu12103083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 11/17/2022] Open
Abstract
There is an evidence-practice gap between the dietary recommendations for age-related macular degeneration (AMD) presented in the literature and those practiced by patients. This study reports on the 3-month post-intervention results of a randomised controlled trial (RCT) evaluating telephone-delivered counselling to improve dietary behaviours among AMD patients. A total of 155 AMD patients (57% female, aged 78 ± 8 years; control: 78, intervention: 77), primarily residing in New South Wales, Australia, were recruited. Participants completed a baseline questionnaire and a short dietary questionnaire (SDQ-AMD). The intervention included an evidence-based nutrition resource and four monthly calls with a dietitian. Immediately post-intervention, intervention participants repeated the SDQ-AMD and completed a feedback form. At 3 months post-intervention, both study arms repeated the SDQ-AMD. Statistical analyses included t-tests and McNemar's test. Intervention participants reported satisfaction with the tailored phone calls, nutrition resource and nutrition education provided. At 3 months post-intervention, there was no statistically significant difference between study arms in the proportion of participants meeting the dietary goals nor in intake (mean servings ± SE) of total vegetables (primary outcome) and other key food groups; however, there was a significantly higher intake of nuts (secondary outcome) (3.96 ± 0.51 vs. 2.71 ± 0.32; p = 0.04) among participants in the intervention versus control group. Within the intervention arm, there were also significant improvements in intakes of the following secondary outcomes: dark green leafy vegetables (0.99 ± 0.17 vs. 1.71 ± 0.22; p = 0.003) and legumes (0.69 ± 0.10 vs. 1.12 ± 0.16; p = 0.02) and intake of sweets and processed/prepared foods (8.31 ± 0.76 vs. 6.54 ± 0.58, p = 0.01). In summary, although there were few dietary differences between study arms at 3 months post-intervention, the intervention involving four monthly calls was acceptable and helpful to the participants. This type of intervention therefore has the potential to provide people with AMD the needed support for improving their nutrition knowledge and dietary practices, especially if continued over a longer period.
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Affiliation(s)
- Diana Tang
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
| | - George Burlutsky
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
| | - Victoria M. Flood
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
- Western Sydney Local Health District, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
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Tahhan N, Ford BK, Angell B, Liew G, Nazarian J, Maberly G, Mitchell P, White AJR, Keay L. Evaluating the cost and wait-times of a task-sharing model of care for diabetic eye care: a case study from Australia. BMJ Open 2020; 10:e036842. [PMID: 33020087 PMCID: PMC7537459 DOI: 10.1136/bmjopen-2020-036842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine whether a collaborative model of care that uses task-sharing for the management of low-risk diabetic retinopathy, Community Eye Care (C-EYE-C), can improve access to care and better use resources, compared with hospital-based care. DESIGN Retrospective audit of medical and financial records to compare two models of care. SETTING A large, urban tertiary Australian publicly funded hospital. INTERVENTION C-EYE-C is a collaborative care model, involving community-based optometrist assessment and 'virtual review' by ophthalmologists to manage low-risk patients. The C-EYE-C model of care was implemented from January to October 2017. PARTICIPANTS New low-risk patient referrals with diabetes received at a tertiary hospital ophthalmology unit. PRIMARY AND SECONDARY OUTCOMES Historical standard hospital care was compared with C-EYE-C for attendance, wait-times, outcomes and costs. Clinical concordance between the optometrist and ophthalmologist diagnosis and management was assessed using weighted kappa statistic. RESULTS There were 133 new low-risk referrals, managed in standard hospital care (n=68) and C-EYE-C (n=65). Attendance rates were similar between the models of care (72.1% hospital vs 67.7% C-EYE-C, p=0.71). C-EYE-C had shorter appointment wait-time (53 vs 118 days, p<0.01). In the C-EYE-C model of care, 68.2% of patients did not require hospital appointments and costs were 43% less than hospital care. There was substantial agreement between optometrists and ophthalmologists for diagnosis (κ=0.64, CI 0.47-0.81) and management (κ=0.66, CI 0.45-0.87). CONCLUSION This Australian study showed that collaborative eye care resulted in reduced patient waiting times and considerable cost-savings, while maintaining a high standard of patient care compared with traditional hospital-based care in the management of low-risk hospital referrals with diabetic eye disease. The improved access and reduced costs were largely the result of better task allocation through greater utilisation of primary eye care professionals to provide services for low-risk patients. Better resource use may free up further resources for other eye care services.
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Affiliation(s)
- Nina Tahhan
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
| | - Belinda Kate Ford
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Ophthalmology, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Blake Angell
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Institute for Global Health, University College London, London, United Kingdom
| | - Gerald Liew
- Department of Ophthalmology, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | | | - Glen Maberly
- Department of Integrated and Community Health, Blacktown Hospital, Western Sydney Local Health District, Blacktown, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - Paul Mitchell
- Department of Ophthalmology, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J R White
- Department of Ophthalmology, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
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Chan TC, Wilkinson Berka JL, Deliyanti D, Hunter D, Fung A, Liew G, White A. The role of reactive oxygen species in the pathogenesis and treatment of retinal diseases. Exp Eye Res 2020; 201:108255. [PMID: 32971094 DOI: 10.1016/j.exer.2020.108255] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 12/15/2022]
Abstract
Reactive oxygen species (ROS) normally play an important physiological role in health regulating cellular processes and signal transduction. The amount of ROS is usually kept in fine balance with the generation of ROS largely being offset by the body's antioxidants. A tipping of this balance has increasingly been recognised as a contributor to human disease. The retina, as a result of its cellular anatomy and physical location, is a potent generator of ROS that has been linked to several major retinal diseases. This review will provide a summary of the role of oxidative stress in the pathogenesis of diabetic retinopathy, age-related macular degeneration, myopia, retinal vein occlusion, retinitis pigmentosa and retinopathy of prematurity. Therapies aimed at controlling oxidative stress in these diseases are also examined.
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Affiliation(s)
- Thomas Cw Chan
- Discipline of Ophthalmology and Eye Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Jennifer L Wilkinson Berka
- Department of Anatomy and Neuroscience, School of Biomedical Sciences, The University of Melbourne, Medical Building 181, Grattan Street, Parkville, Victoria, 3010, Australia; Department of Diabetes, The Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia
| | - Devy Deliyanti
- Department of Anatomy and Neuroscience, School of Biomedical Sciences, The University of Melbourne, Medical Building 181, Grattan Street, Parkville, Victoria, 3010, Australia; Department of Diabetes, The Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia
| | - Damien Hunter
- Discipline of Ophthalmology and Eye Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Centre for Vision Research, Westmead Institute of Medical Research, New South Wales, Australia
| | - Adrian Fung
- Westmead and Central Clinical Schools, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Faculty of Medicine Health and Human Sciences, Macquarie University, New South Wales, Australia; Save Sight Institute, 8 Macquarie St, Sydney, Australia
| | - Gerald Liew
- Discipline of Ophthalmology and Eye Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Centre for Vision Research, Westmead Institute of Medical Research, New South Wales, Australia
| | - Andrew White
- Discipline of Ophthalmology and Eye Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Centre for Vision Research, Westmead Institute of Medical Research, New South Wales, Australia; Save Sight Institute, 8 Macquarie St, Sydney, Australia; Personal Eyes, Level 6, 34 Charles St, Parramatta, 2150, Australia.
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Ford B, Keay L, Angell B, Hyams S, Mitchell P, Liew G, White A. Quality and targeting of new referrals for ocular complications of diabetes from primary care to a public hospital ophthalmology service in Western Sydney, Australia. Aust J Prim Health 2020; 26:293-299. [PMID: 32659209 DOI: 10.1071/py20084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/04/2020] [Indexed: 01/03/2023]
Abstract
Patients with diabetes require regular examination for eye disease, usually in primary care settings. Guidelines recommend patients with at least moderate non-proliferative diabetic retinopathy (NPDR) be referred to an ophthalmologist for treatment; however, poorly targeted referrals lead to access blocks. The quality of new referrals associated with diabetes to a public ophthalmology service in Sydney, New South Wales, Australia, were assessed for referral completeness and targeting. A cross-sectional audit of medical records for new patients referred to Westmead Hospital Eye Clinic in 2016 was completed. Completeness of medical and ophthalmic information in referrals and subsequent patient diagnosis and management in 2016-17 was recorded. Sub-analyses were conducted by primary care referrer type (GP or optometrist). In total, 151 new retinopathy referrals were received; 12% were sent directly to a treatment clinic. Information was incomplete for diabetes status (>60%), medical (>50%) and ophthalmic indicators (>70%), including visual acuity (>60%). GP referrals better recorded medical, and optometrists (37%) ophthalmic information, but information was still largely incomplete. Imaging was rarely included (retinal photos <1%; optical coherence tomography <3%). Median appointment wait-time was 124 days; 21% of patients received treatment (laser or anti-vascular endothelial growth factor) at this or the following encounter. Targeting referrals for ocular complication of diabetes to public hospitals needs improvement. Education, feedback and collaborative care mechanisms should be considered to improve screening and referral in primary care.
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Affiliation(s)
- Belinda Ford
- The George Institute for Global Health, UNSW Sydney, 1 King Street, Newtown, NSW 2042, Australia; and Westmead Hospital Ophthalmology Department, WSLHD, Corner Hawkesbury Road and Darcy Road, Sydney, NSW 2145, Australia; and Corresponding author.
| | - Lisa Keay
- The George Institute for Global Health, UNSW Sydney, 1 King Street, Newtown, NSW 2042, Australia; and School of Optometry and Vision Science, Faculty of Science, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Blake Angell
- The George Institute for Global Health, UNSW Sydney, 1 King Street, Newtown, NSW 2042, Australia
| | - Stephanie Hyams
- Centre for Vision Research, Westmead Institute for Medical Research, 176 Hawkesbury Road Sydney, NSW 2145, Australia
| | - Paul Mitchell
- Westmead Hospital Ophthalmology Department, WSLHD, Corner Hawkesbury Road and Darcy Road, Sydney, NSW 2145, Australia; and Centre for Vision Research, Westmead Institute for Medical Research, 176 Hawkesbury Road Sydney, NSW 2145, Australia
| | - Gerald Liew
- Westmead Hospital Ophthalmology Department, WSLHD, Corner Hawkesbury Road and Darcy Road, Sydney, NSW 2145, Australia; and School of Optometry and Vision Science, Faculty of Science, UNSW Sydney, Sydney, NSW 2052, Australia; and Centre for Vision Research, Westmead Institute for Medical Research, 176 Hawkesbury Road Sydney, NSW 2145, Australia
| | - Andrew White
- Westmead Hospital Ophthalmology Department, WSLHD, Corner Hawkesbury Road and Darcy Road, Sydney, NSW 2145, Australia; and School of Optometry and Vision Science, Faculty of Science, UNSW Sydney, Sydney, NSW 2052, Australia; and Centre for Vision Research, Westmead Institute for Medical Research, 176 Hawkesbury Road Sydney, NSW 2145, Australia
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Liew G, Tse B, Ho IV, Joachim N, White A, Pickford R, Maltby D, Gopinath B, Mitchell P, Crossett B. Acylcarnitine Abnormalities Implicate Mitochondrial Dysfunction in Patients With Neovascular Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2020; 61:32. [PMID: 38755790 PMCID: PMC7425723 DOI: 10.1167/iovs.61.8.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/22/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose Abnormalities in lipid metabolism are implicated in age-related macular degeneration (AMD), but the pathways involved remain unclear. We assessed whether acylcarnitine concentrations, a marker of lipid and mitochondrial metabolism, differed between patients with AMD and controls. Methods In this cross-sectional case-control study, cases (n = 81) had neovascular AMD and controls (n = 79) had cataract with no other ocular pathology. Participants were recruited from eye clinics in Western Sydney, Australia, between 2016 and 2018. Plasma blood samples were collected and liquid chromatography mass spectrometry analyses performed to identify acylcarnitine concentrations. Acylcarnitine levels were adjusted for age, gender and smoking in multivariable models. Confirmation of key acylcarnitine identities was conducted using high mass accuracy liquid chromatography-tandem mass spectrometry. Results After multivariable adjustment, C2-carnitine (acetylcarnitine) levels were significantly lower in patients with neovascular AMD compared to controls (0.810 ± 0.053 (standard error) compared to 1.060 ± 0.053), p = 0.002). C18:2-DC carnitine (a dicarboxylic acylcarnitine with a 18 carbon side chain and 2 double bonds), levels were significantly higher in patients with neovascular AMD compared to controls (1.244 ± 0.046 compared to 1.013 ± 0.046), p = 0.001). Other acylcarnitines examined were not significantly different between cases and controls. Conclusions Reduced plasma levels of C2-carnitine (acetylcarnitine) and increased plasma levels of C18:2-DC carnitine were observed in patients with neovascular AMD compared to controls. These findings suggest mitochondrial dysfunction could be involved in the pathogenesis of neovascular AMD.
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Affiliation(s)
- Gerald Liew
- Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), Westmead Millennium Institute for Medical Research, University of Sydney, Sydney, Australia
- Retina Associates, Sydney, Australia
| | - Benita Tse
- Charles Perkins Centre, University of Sydney, Sydney, Australia
- Sydney Mass Spectrometry, University of Sydney, Sydney, Australia
| | - I-Van Ho
- Retina Associates, Sydney, Australia
| | - Nichole Joachim
- Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), Westmead Millennium Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Andrew White
- Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), Westmead Millennium Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Russell Pickford
- Bioanalytical Mass Spectrometry Facility, University of New South Wales, Kensington, Australia
| | - David Maltby
- Sydney Mass Spectrometry, University of Sydney, Sydney, Australia
| | - Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), Westmead Millennium Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), Westmead Millennium Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Ben Crossett
- Sydney Mass Spectrometry, University of Sydney, Sydney, Australia
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Han X, Gharahkhani P, Mitchell P, Liew G, Hewitt AW, MacGregor S. Genome-wide meta-analysis identifies novel loci associated with age-related macular degeneration. J Hum Genet 2020; 65:657-665. [PMID: 32277175 DOI: 10.1038/s10038-020-0750-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/19/2022]
Abstract
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness among the elderly population. To accelerate the understanding of the genetics of AMD, we conducted a meta-analysis of genome-wide association studies (GWAS) combining data from the International AMD Genomics Consortium AMD-2016 GWAS (16,144 advanced AMD cases and 17,832 controls), AMD-2013 GWAS (17,181 cases and 60,074 controls), and new data on 4017 AMD cases and 14,984 controls from Genetic Epidemiology Research on Aging study. We identified 12 novel AMD loci near or within C4BPA-CD55, ZNF385B, ZBTB38, NFKB1, LINC00461, ADAM19, CPN1, ACSL5, CSK, RLBP1, CLUL1, and LBP. We then replicated the associations of the novel loci in independent cohorts, UK Biobank (5860 cases and 126,726 controls) and FinnGen (1266 cases and 47,560 control). In general, the concordance in effect sizes was very high (correlation in effect size estimates 0.89), 11 of 12 novel loci were in the expected direction, 5 were associated with AMD at a nominal significance level, and rs3825991 (near gene RLBP1) after Bonferroni correction. We identified an additional 21 novel genes using a gene-based test. Most of the novel genes are expressed in retinal tissue and could be involved in the pathogenesis of AMD (i.e., complement, inflammation, and lipid pathways). These findings enhance our understanding of the genetic architecture of AMD and shed light on the biological process underlying AMD pathogenesis.
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Affiliation(s)
- Xikun Han
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia. .,School of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Puya Gharahkhani
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Paul Mitchell
- Department of Ophthalmology, Centre for Vision Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Gerald Liew
- Department of Ophthalmology, Centre for Vision Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Alex W Hewitt
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.,Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC, Australia
| | - Stuart MacGregor
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
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Jalbert I, Rahardjo D, Yashadhana A, Liew G, Gopinath B. A qualitative exploration of Australian eyecare professional perspectives on Age-Related Macular Degeneration (AMD) care. PLoS One 2020; 15:e0228858. [PMID: 32045445 PMCID: PMC7012424 DOI: 10.1371/journal.pone.0228858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/25/2020] [Indexed: 01/22/2023] Open
Abstract
Despite the existence of evidence-based recommendations to decrease risk and progression of Age-Related Macular Degeneration (AMD) for some time, self-reported practices suggest that eyecare professionals' advice and people with AMD's adherence to these recommendations can be very poor. This study uses qualitative methods to explore Australian eyecare professionals' perspective on barriers to effective AMD care. Seven focus groups involving 65 optometrists were conducted by an experienced facilitator. A nominal group technique was used to identify, prioritize and semi-quantify barriers and enablers to AMD care. Participants individually ranked their perceived top five barriers and enablers with the most important granted a score of 5 and the least important a score of 1. For each barrier or enabler, the number of votes it received and its total score were recorded. Barriers and enablers selected by at least one participant in their top 5 were then qualitatively analysed, grouped using thematic analysis and total score calculated for each consolidated barrier or enabler. In-depth individual interviews were conducted with 10 ophthalmologists and 2 optometrists. Contributions were audio-recorded, transcribed verbatim and analysed with NVivo software. One hundred and sixty-nine barriers and 51 enablers to AMD care were identified in the focus groups. Of these, 102 barriers and 42 enablers were selected as one of their top 5 by at least one participant and further consolidated into 16 barriers and 10 enablers after thematic analysis. Factors impacting AMD care identified through analysis of the transcripts were coded to three categories of influence: patient-centered, practitioner-centered, and structural factors. Eyecare professionals considered poor care pathways, people with AMD's poor disease understanding / denial, and cost of care / lack of funding, as the most significant barriers to AMD care; they considered shared care model, access, and communication as the most significant enablers to good AMD care. These findings suggest that Australian eyecare professionals perceive that there is a need for improved patient support systems and appropriately funded, clearer care pathway to benefit people with AMD.
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Affiliation(s)
- Isabelle Jalbert
- School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia
| | - Dian Rahardjo
- School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia
| | - Aryati Yashadhana
- School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
| | - Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology, The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
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Dharamdasani Detaram H, Mitchell P, Russell J, Burlutsky G, Liew G, Gopinath B. Dietary zinc intake is associated with macular fluid in neovascular age‐related macular degeneration. Clin Exp Ophthalmol 2019; 48:61-68. [DOI: 10.1111/ceo.13644] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/14/2019] [Indexed: 01/29/2023]
Affiliation(s)
- Harshil Dharamdasani Detaram
- Centre for Vision Research, Department of Ophthalmology and The Westmead Institute for Medical ResearchThe University of Sydney Sydney New South Wales Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology and The Westmead Institute for Medical ResearchThe University of Sydney Sydney New South Wales Australia
| | - Joanna Russell
- Faculty of Social Sciences, School of Health and SocietyUniversity of Wollongong Sydney New South Wales Australia
| | - George Burlutsky
- Centre for Vision Research, Department of Ophthalmology and The Westmead Institute for Medical ResearchThe University of Sydney Sydney New South Wales Australia
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology and The Westmead Institute for Medical ResearchThe University of Sydney Sydney New South Wales Australia
| | - Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology and The Westmead Institute for Medical ResearchThe University of Sydney Sydney New South Wales Australia
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Detaram HD, Joachim N, Liew G, Vu KV, Burlutsky G, Mitchell P, Gopinath B. Smoking and treatment outcomes of neovascular age-related macular degeneration over 12 months. Br J Ophthalmol 2019; 104:893-898. [PMID: 31558491 DOI: 10.1136/bjophthalmol-2019-314849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/27/2019] [Accepted: 09/15/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND To assess the association of smoking with age of onset of neovascular age-related macular degeneration (nAMD), visual acuity (VA), central macular thickness (CMT) and the presence of fluid in patients with nAMD. METHODS 547 patients with nAMD were recruited from a tertiary eye clinic during 2012-2015; of these, 490 patients were followed up 12 months later. Clinical diagnosis of nAMD was confirmed by a retinal specialist. Smoking was determined from self-reported history as never, past or current. Age of onset was defined as date of first recorded diagnosis of nAMD in either eye or date of first anti-vascular endothelial growth factor injection. CMT and presence of fluid were recorded from spectral-domain optical coherence tomography images. VA was recorded as number of letters read at 3 m. RESULTS After multivariable adjustment, current smokers developed nAMD at an average 5.5 years younger age than never smokers and 4.4 years younger age than past smokers (p<0.0001 and p=0.0008, respectively). At baseline, adjusted mean CMT was significantly higher in current compared with past smokers (259.2 µm vs 231.9 µm, respectively, p=0.04). Current smokers versus never smokers had greater odds of presence of subretinal fluid at 12-month follow-up: multivariable-adjusted OR 1.99 (95% CI 1.09 to 3.67). Smoking status was not significantly associated with VA over 12 months. CONCLUSIONS Current smoking was associated with a younger age of nAMD onset and key treatment outcomes such as higher mean CMT and greater odds of subretinal fluid presence. These findings suggest that smoking cessation may benefit patients being treated for nAMD.
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Affiliation(s)
- Harshil Dharamdasani Detaram
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Nichole Joachim
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Kim Van Vu
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - George Burlutsky
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
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Abstract
Objectives: We aimed to assess the cross-sectional associations between sensory impairments (vision, hearing, and/or olfactory loss) and handgrip strength. Method: In the Blue Mountains Eye Study, 947 participants aged 65+ years had handgrip strength measured using a dynamometer. Visual impairment was defined as visual acuity <20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold >25 dBHL (500-4,000 Hz). Olfaction was measured using the San Diego Odor Identification Test. Results: Marginally significant associations between sensory impairment and handgrip strength were observed after multivariable adjustment. For example, women with two or three sensory impairments had lower adjusted mean handgrip strength (17.47 ± 0.5 kg) versus women who had no sensory loss (18.59 ± 0.3 kg; p = .06) or only one sensory impairment (18.58 ± 0.3 kg; p = .05), respectively. No significant associations were observed in men. Discussion: Women who had multiple sensory impairments had reduced muscle strength as indicated by ~1.1 kg lower mean handgrip strength.
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Affiliation(s)
| | - Gerald Liew
- The University of Sydney, New South Wales, Australia
| | | | - Paul Mitchell
- The University of Sydney, New South Wales, Australia
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47
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Liew G, Mitchell P, Chiha J, Plant AJH, White A, Joachim N, Wang S, Burlutsky G, Kovoor P, Thiagalingam A, Gopinath B. Retinal microvascular changes in microvascular angina: Findings from the Australian Heart Eye Study. Microcirculation 2019; 26:e12536. [PMID: 30758094 DOI: 10.1111/micc.12536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Microvascular changes in microvascular angina are poorly understood due to difficulties in imaging the coronary microcirculation in vivo. The retinal microvasculature may reflect changes in coronary microcirculation. We assessed microvascular changes in the retina in patients with microvascular angina and compared them with patients with angiographically proven coronary artery disease. METHODS We performed retinal photography and coronary angiography on 915 patients. Retinal vessel calibers were measured using a validated computer-assisted method; coronary artery disease was graded from coronary angiograms. Microvascular angina was defined as angina with <25% stenosis in all coronary epicardial arteries. RESULTS A total of 139 patients (15.2%) had microvascular angina, while 776 (84.8%) had coronary artery disease. Participants with microvascular angina and coronary artery disease had similar retinal arteriolar and venular calibers. After adjustment for age, ethnicity, mean arterial pressure, diabetes, current smoking, body mass index, and fellow vessel caliber, women with smaller venules were threefold more likely to have microvascular angina than women with larger venules (multivariable-adjusted odds ratio 3.54, 95% confidence interval 1.35 to 9.24, P < 0.01). This difference was not observed in men. CONCLUSIONS Microvascular angina in women was associated with microvascular changes distinct from those in coronary artery disease.
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Affiliation(s)
- Gerald Liew
- Centre for Vision Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Mitchell
- Centre for Vision Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Joseph Chiha
- Centre for Heart Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Adam J H Plant
- Centre for Vision Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew White
- Centre for Vision Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Nichole Joachim
- Centre for Vision Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Wang
- Centre for Vision Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - George Burlutsky
- Centre for Vision Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Pramesh Kovoor
- Centre for Heart Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Aravinda Thiagalingam
- Centre for Heart Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Bamini Gopinath
- Centre for Vision Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
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Abstract
INTRODUCTION Age-related macular degeneration (AMD) is a leading cause of blindness. After smoking, nutrition is the key modifiable factor in reducing AMD incidence and progression, and no other preventative treatments are currently available. At present, there is an evidence-practice gap of dietary recommendations made by eye care practitioners and those actually practised by patients with AMD. To address this gap, a telephone-delivered dietary intervention tailored to patients with AMD will be piloted. The study aims to improve dietary intake and behaviours in patients with AMD. This type of nutrition-focused healthcare is currently not considered in the long-term management of AMD and represents the first empirical evaluation of a telephone-supported application encouraging adherence to dietary recommendations for AMD. METHODS AND ANALYSIS 140 participants with AMD will be recruited for this randomised controlled trial. Those lacking English fluency; unwilling to engage in the intervention or provide informed consent were excluded. Following the completion of the baseline questionnaire, participants will be randomised into one of two arms: intervention or wait-list control (70 each in the intervention and control groups). Intervention participants will receive a detailed mail-delivered workbook containing information on healthy eating behaviours that promote optimal macular health, as well as scheduled phone calls over 4 months from an accredited practising dietitian. Descriptive statistics and multivariate stepwise linear regressions analyses will be used to summarise and determine the changes in dietary intakes, respectively. Economic analysis will be conducted to determine intervention feasibility and possibility of a large-scale rollout. ETHICS AND DISSEMINATION The study was approved by the University of Sydney Human Research Ethics Committee (HREC) (Reference: HREC 2018/219). Study findings will be disseminated via presentations at national/international conferences and peer-reviewed journal articles. TRIAL REGISTRATION NUMBER ACTRN12618000527268; Pre-results.
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Affiliation(s)
- Diana Tang
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Victoria Flood
- Western Sydney Local Health District, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Health Sciences, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Annette Kifley
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Alison Hayes
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
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Abstract
PURPOSE The population prevalence of diabetic macular oedema (DME) is unclear. Previous estimates have depended on photographic grading of clinically significant macular oedema, which is subjective and has resulted in widely varying estimates. With the advent of optical coherence tomography (OCT), the presence and severity of DME can now be assessed objectively and accurately. METHODS The Liverpool Eye and Diabetes Study (LEADS) is a cross-sectional population-based study of patients with type 1 and type 2 diabetes in a multi-ethnic region of Sydney, Australia, to determine the population prevalence of OCT-defined DME, how this varies by ethnicity and association with systemic factors. This report describes the rationale, methodology and study aims. RESULTS To date 646 patients out of an expected sample size of 2000 have been recruited. Baseline data are presented for patients with type 1 (n=75, 11.8%) and type 2 (n=562, 88.2%) diabetes recruited to date. Patients with type 1 diabetes were younger (39.5vs60.7 years), with longer duration of diabetes (18.1vs11.7 years), slightly worse glycaemic control (HbA1c 9.0vs8.3), and less likely to have hypertension (30.7vs71.4%), hypercholesterolaemia (33.3vs74.6%) and obesity (31.1vs51.5%, respectively, all p<0.05). CONCLUSIONS The LEADS will provide objective estimates of the population prevalence of DME, how this varies with ethnicity and associations with systemic disease.
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Affiliation(s)
- Gerald Liew
- South West Retina, Retina Associates, Liverpool, New South Wales, Australia
- Centre for Vision Research, Westmead Millennium Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Vincent W Wong
- Liverpool Diabetes Collaborative Research Unit, Ingham Institute of Applied Science, Sydney, New South Wales, Australia
| | - Mercy Saw
- Liverpool Diabetes Collaborative Research Unit, Ingham Institute of Applied Science, Sydney, New South Wales, Australia
| | - Tania E Tsang
- South West Retina, Retina Associates, Liverpool, New South Wales, Australia
| | - Tim Nolan
- South West Retina, Retina Associates, Liverpool, New South Wales, Australia
| | - Stephen Ong
- South West Retina, Retina Associates, Liverpool, New South Wales, Australia
| | - I-Van Ho
- South West Retina, Retina Associates, Liverpool, New South Wales, Australia
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
- Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia
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Ho IV, Fernandez-Sanz G, Levasseur S, Ting E, Liew G, Playfair J, Downie J, Gorbatov M, Hunyor AP, Chang AA. Early Pars Plana Vitrectomy for Treatment of Acute Infective Endophthalmitis. Asia Pac J Ophthalmol (Phila) 2019; 8:3-7. [PMID: 30666852 DOI: 10.22608/apo.2018414] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of early pars plana vitrectomy (PPV) for the treatment of acute infective endophthalmitis, and identify prognostic factors for better visual outcome. DESIGN Retrospective cohort study. METHODS Consecutive patients who underwent early PPV within 72 hours of presentation for the treatment of acute infective bacterial endophthalmitis and presented to a large tertiary referral center in New South Wales, Australia, between January 2009 and December 2013 were included. Changes in best-corrected visual acuity (VA) from baseline to 1 year were examined. RESULTS A total of 64 patients were included. The inciting events were cataract surgery (53%), intravitreal injection (36%), trabeculectomy (3%), and endogenous (3%). The mean VA improved from 3.1 logMAR (hand motion) at baseline to 1.02 (approximately 20/200) at 1 year, with 42% achieving final VA equal to or better than 0.477 logMAR (20/60) following early PPV. Positive prognostic factors were negative microbial cultures (P < 0.01) and etiology of post-cataract surgery (P < 0.01). In multivariable analyses adjusting for age and prognostic factors, patients with baseline VA of light perception and hand motion achieved greater visual gains than those with counting fingers, with gains of logMAR of -2.68, -2.09, and -0.85, respectively (P < 0.0001). CONCLUSIONS Most patients who undergo early PPV experience substantial VA improvement. Negative microbial cultures and endophthalmitis after cataract surgery were associated with better final visual outcome. Patients with presenting VA of light perception or hand motion achieved higher visual gains than those with counting fingers, suggesting the possibility that early PPV may be beneficial in both groups.
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Affiliation(s)
- I-Van Ho
- Retina Unit, Sydney Eye Hospital, Sydney, NSW, Australia
- Retina Associates, Sydney, NSW, Australia
| | - Guillermo Fernandez-Sanz
- Retina Unit, Sydney Eye Hospital, Sydney, NSW, Australia
- Clinica Universidad de Navarra, Madrid, Spain
| | | | - Eugene Ting
- Retina Unit, Sydney Eye Hospital, Sydney, NSW, Australia
- Retina Associates, Sydney, NSW, Australia
| | - Gerald Liew
- Retina Associates, Sydney, NSW, Australia
- Westmead Institute of Medical Research, University of Sydney, NSW, Australia
| | - Justin Playfair
- Retina Unit, Sydney Eye Hospital, Sydney, NSW, Australia
- Retina Associates, Sydney, NSW, Australia
| | - John Downie
- Retina Unit, Sydney Eye Hospital, Sydney, NSW, Australia
- Sydney Retina Clinic and Day Surgery, Sydney, NSW, Australia
| | - Mark Gorbatov
- Retina Unit, Sydney Eye Hospital, Sydney, NSW, Australia
| | - Alex P Hunyor
- Retina Unit, Sydney Eye Hospital, Sydney, NSW, Australia
- Retina Associates, Sydney, NSW, Australia
| | - Andrew A Chang
- Retina Unit, Sydney Eye Hospital, Sydney, NSW, Australia
- Retina Consultants, Sydney, NSW, Australia
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